Prayers

The Chairman of Ways and Means took the Chair as Deputy Speaker (Standing Order No. 3).

Nick Smith: I beg to move, That the House sit in private.
Question put forthwith (Standing Order No. 163), and negatived.

Eleanor Laing: I thank the hon. Gentleman for his motion, which is roundly defeated.

Menopause (Support and Services) Bill

Second Reading

Carolyn Harris: I beg to move, That the Bill be now read a Second time.
The private Members’ Bills ballot at the start of each Session of Parliament gives each of us the opportunity to put in to champion a cause that we believe will make a real difference. When I was drawn at No. 3, I thought long and hard about what I should focus on. I wanted an issue that meant something to me and that would make a difference in the lives of people who really need it—not just in my constituency, but right across the UK. Being the only female Member drawn in the top seven, I particularly wanted to focus on something that would improve the lives of women up and down the country, and so the Menopause (Support and Services) Bill began to take shape in my head.
I have said all along that this Bill and the menopause more widely is not a political issue, and I maintain that. Women’s health should never be political. So I am not here today to win points; I am here because, right now, menopause support in this country, and indeed around the world, is falling short and failing women. GP training in medical schools, support in workplaces, public health messaging and curriculum content in our schools all need addressing, and I will come to each of those in turn in my speech.
However, I needed more: I needed something that only a change of legislation would put right, and it was a conversation with one of my colleagues in this place that gave me that something. I have always considered myself very fortunate to be a Welshwoman, and why wouldn’t I?—we are taking over the world, guys—but it had not occurred to me until that conversation that there was another reason why being Welsh was an advantage: NHS prescriptions are free in Wales. My colleague, on the other hand, was off to pick up her hormone replacement therapy prescription and was going to pay for it. She could afford to pay for it, but not everyone can. It was one of those eureka moments when I realised that this was the final piece in the jigsaw  of my menopause Bill, which was always going to be about raising awareness and bringing a focus to the menopause as an issue we all need to consider.
Some 51% of the population are female, which means that 51% of us will personally experience the menopause at some point in our lives. Our experiences will all be unique. Some will sail through and barely notice. Others will suffer the most extreme symptoms: headaches, hot flushes, night sweats, brain fog, brittle nails, weight gain, insomnia, anxiety, low libido, vaginal dryness—and I could go on and on. Many women will present at their GP’s with one or more of those symptoms, and that can be the first hurdle. With 41% of medical schools offering no mandatory menopause training at all, thousands of GPs are qualifying and entering practice with no knowledge of how to diagnose menopause.

Tim Loughton: I congratulate the hon. Lady on again bringing a taboo subject out of the shadows. I am delighted, as one of the 49%, to be a sponsor of her Bill, not just because she would have beaten me up if I had not been, but because this is a genuinely needed and worthwhile Bill. Does she agree with me that it is not just the 51% or the 13 million who are peri or post-menopausal who are affected, but that it affects many of the 49% and younger women? Many of the conditions that she has described are a huge additional cost to the NHS that, if prescribed for properly—and diagnosed properly—would save a lot of money for the NHS and an awful lot of angst for many women going through that, and the people around them.

Carolyn Harris: I agree with the hon. Gentleman and thank him for sponsoring the Bill. I would say that this is about not just the symptoms women feel, but the consequences in relationships; we have seen far too many marriages and relationships fall by the wayside because of menopause and its symptoms, and now is the time to change all that.
Women presenting to their doctor are often diagnosed with anxiety and depression. That happened to me and I have told my story previously: I presented to my GP believing I was having a nervous breakdown and ended up on antidepressants for 11 years. It was only when I spoke to friends and colleagues in this place and we shared conversations that people do not normally have—or did not have until now—that I realised that many other women were also experiencing what I was experiencing. That means we are seeing women being prescribed antidepressants when hormone replacement therapy may well have been more suitable, or presenting with insomnia and being given sleeping tablets when HRT may well have been more suitable, or being sent to consultants for tests for early onset dementia when visiting their GP about their brain fog and forgetfulness when, again, HRT may well have been more suitable. As hormone levels drop, women are at greater risk of developing a series of other conditions—cardiovascular disease, osteoporosis, type 2 diabetes, obesity, osteoarthritis, depression and dementia—and the cost of investigating and treating these as well as the other additional appointments is putting extra unnecessary pressure on our NHS.
I have heard countless stories of misdiagnosis. As  I have said, I went on to suffer for 11 years with what I considered to be depression. Little did I know that over  a decade later when I started HRT, I would see my life become transformed and I would have more energy. God, isn’t that scary: more energy? My husband is heading for the backdoor now. But we cannot blame GPs; we must make sure our medical schools reassess their curriculums so in future doctors are educated in the menopause and are able to offer all women the same high-quality care and support. Women are routinely called for cervical smears and breast screening; we need to see them being called for a menopause check-up around the time they turn 40. This would be a quick and an easy solution to helping women become more aware of the symptoms so that they are prepared and, importantly, educated in the available treatments.

Robert Buckland: I join the warm tributes to the hon. Lady’s genuine cross-party approach to this; it is a testament to her campaigning ability.
I was particularly struck by clause 2 of her Bill which talks about the wider strategy. Does she agree that while HRT is a wonderful prescription for many women there will be some for whom it is not suitable, and therefore wider issues about menopause awareness and training are going to be important if we are to reach as many women and their families as possible?

Carolyn Harris: I do agree and my mantra has become that we can all become menopause warriors because that means we acknowledge the issues and problems and are prepared to work towards ameliorating them.
We can look at the good practice out there to see what can be done. I recently spoke to practice nurse Sharon Hartmann from Tudor Lodge surgery in Weston-super-Mare. The surgery supported Sharon to develop a special interest in menopause care. She is now certified by the British Menopause Society and delivers evidence-based practice to her patients. She is able to monitor progress, control treatment plans and prescribe suitable medication for each individual. I would love to see this kind of service in surgeries or clusters all over the country, with doctors being able to identify the symptoms quickly and ensuring women are then passed down to someone with a wealth of knowledge and experience in menopause care. But it is not just the education of the medical profession that needs attention. We need to address education in our schools, so that the next generation of girls and boys is far more prepared than any of us were. I certainly did not talk about the menopause when I was at school. We did not even talk about periods when I was at school. We want the next generation to talk openly about it, understand what is to come and what they can do to help. We need young men to understand that their mothers, wives, sisters and partners may struggle at some point in their life, and that it is not that they do not love them any more, it is just that the menopause is denying them emotion.

Esther McVey: I, too, congratulate the hon. Lady on bringing forward this issue and pursuing it in such a constructive, positive and enthusiastic way not just in the House but outside it too, and on the points she raises about the stigma attached to the menopause and the idea that women of a certain age are maybe past their prime. Absolutely not. People need to know that  women’s lives actually might begin at 50. Thank you for what you have done and, I understand, for your constructive work with the Government. What you are doing today is a most important step forward—

Eleanor Laing: Order. I cannot let the right hon. Lady, who is a senior Member of the House, say “you” when she means “her”. Could she just say it again, just to please me?

Esther McVey: I was carried away by the excitement of the moment, but you are quite right, Madam Deputy Speaker. The hon. Lady has done so much and will earn the gratitude of the whole country for what she is doing with this positive step forward today.

Carolyn Harris: I agree with everything the right hon. Lady says.
It has been a pleasure to work with some fantastic women in this place who understand how important this issue is and, like me, want to ensure it is at the top of the agenda. The Minister, her predecessor, our shadow Minister, and all my cross-party colleagues and friends have been absolutely fantastic. We are so lucky to have strong male voices, too, who have not only signed the Bill but are here to support it. I want to thank—good grief, the hon. Member for Strangford (Jim Shannon) is not in his place! That is a first. I thank the hon. Members for Strangford and for Hazel Grove (Mr Wragg), my hon. Friends the Members for Bootle (Peter Dowd) and for Blaenau Gwent (Nick Smith), and the hon. Member for East Worthing and Shoreham (Tim Loughton) to name just a few, men who are not afraid to embrace the menopause revolution and have shown themselves to be dedicated menopause warriors.
I am sure we would have heard the voice of our dearly missed colleague, the former Member for Southend West, today if it were not for tragic events. I remember him coming to a menopause event I hosted a couple of years ago. When I asked him if he supported the cause, he told me, “With a wife and four daughters at home, I don’t have any option.” [Laughter.] So today, I would like to add my voice to those who have already spoken in the Chamber and around the country, and send my thoughts and prayers to his wife, his four daughters and his son. David was a very special man and we all miss him greatly. [Hon. Members: “Hear, hear.”]
We need to go further on education. We need to educate ourselves now. A public health campaign would help enormously, as so many women just do not join the dots between their own health issues and the menopause. As I mentioned earlier, 11 years ago I had no idea what was happening to me. If my inbox is anything to go by, I am not alone. I know from conversations I have had with friends and colleagues in this place that they, too, were not sure of the situation they found themselves in because it has been a taboo subject. It has been a dirty little secret that women were ashamed of. My earliest recollection of “the change” was a comedy sketch by Les Dawson dressed as a woman having a conversation over a fake wall with Roy Barraclough, lifting his left breast and referring to his neighbour as “being on the change”. We have to move on from those days. It is not a joke when you live with it and it is not a joke when you experience it. We can do so much more to make sure we do the right thing.
Well, I am not ashamed. That is maybe because I am Welsh and I say what I think. Fortunately, there are a lot of other people out there who are not ashamed. It is fantastic that celebrities such as Davina McCall, Lisa Snowdon, Mariella Frostrup, Penny Lancaster, Nadia Sawalha and Gabby Logan are all sharing their menopause experiences. As the right hon. Member for Tatton (Esther McVey) said, it is sometimes very difficult for someone to talk about their menopause when they are in a profession, because the assumption is made that they are over the hill.
There are some great tools to help us, too, such as the Balance app and the Henpicked website, which provide a wealth of unbiased and factual information about the menopause and aid women in taking control of their health. But it is our responsibility in this place to look at what we can do to ensure that the right message gets to everyone who needs it.

Ruth Cadbury: I congratulate my hon. Friend on introducing this Bill, on her passion and on raising it as an issue not just of medical training, but of realisation and understanding for everyone—men and women. Does she agree that one of the challenges in this area is the historical nervousness about taking HRT? The world has moved on since our mothers’ generation, when there were some real problems, and medical knowledge has improved. Does she agree that we need more education on the benefits of HRT, which she has so personally described?

Carolyn Harris: I certainly agree. The information that would explain the situation with HRT is out there, but because we are not looking for it, we do not find it. There is really good information that debunks the myths on HRT, which has moved on a lot. It is a phenomenally different product from what it was in the day when too many people were prepared to criticise the use of it. Unfortunately, if someone does not look for that information, they will not find it and they do not prescribe HRT.
Someone understanding their own menopause is so important. Although we are, I hope, heading towards a time when women will discuss their experiences with family and friends, there is also a lot to be done in workplaces, where talking about symptoms can be a lot harder. Employers have a huge role to play in ensuring that support is available and understanding what their staff are experiencing. I have heard far too many accounts of women being given warnings, being sacked or even being made to feel that they have no choice other than to resign due to menopausal symptoms.

Seema Malhotra: I congratulate my hon. Friend on this most excellent Bill and on the work of the all-party group on menopause. The work of the group also helped to inspire activity with employers across the country. I attended an event on the menopause with Shevaun Haviland, the new head of the British Chambers of Commerce, and the Dorset chamber. There was tremendous engagement from employers, who had never been able to have this kind of conversation. Does my hon. Friend agree that, alongside improving awareness in the medical profession and in society to help to encourage discussion in families, supporting employers to have this conversation is vital for their understanding and for women’s employment?

Carolyn Harris: I certainly do. Very many businesses—really big players in their fields—have contacted me and asked for advice on how they can move forward. What I say to them all is, “Don’t have a policy that is left in a filing cabinet that reflects a tick box. Have a policy that reflects your workforce and what women need and is intended to help them.” I visited several big companies that are really good employers and I have seen the all-singing, all-dancing menopause policy that does all but make a cup of tea, but when I asked the staff, “How is the menopause policy working for you?”, their response was, “I didn’t know we had one.” It cannot be a tick box; it has to be relevant.
Other employers need to take heed of the likes of Timpson—I repeat that James Timpson walks on water, as I said in this Chamber last week—in prioritising the welfare of its staff who are experiencing symptoms of the perimenopause or menopause. There are other big companies, such as PricewaterhouseCoopers, Bristol Myers Squibb and Tesco, that do good work—I could go on, but I know that the right hon. Member for Romsey and Southampton North (Caroline Nokes), who chairs the Women and Equalities Committee, will talk about that.

Stephen Kinnock: I pay tribute to the amazing campaign that my hon. Friend is running. The Bill is making such an important contribution; I think we all sign up to being menopause warriors and menopause revolutionaries. To add to the point about employers, does she see a role for trade unions in promoting the excellent ideas that are in the Bill? Can she give some examples of how we as MPs and menopause warriors could do more in our constituencies to encourage employers and trade unions to take these ideas forward?

Carolyn Harris: I have always thought of my hon. Friend as being Amazonian in his warrior status. I am sure that when he has his photograph taken later today with the lovely Penny Lancaster, he will prove to be Amazonian. In his constituency, the Community union is doing fantastic work with Tata Steel, which has welcomed in the union to hold menopause coffee mornings with the women in its workforce, who, let us not forget, are working in a very male-dominated arena. If they can do it, so many others can. My hon. Friend the Member for Newport East (Jessica Morden) has the Llanwern steelworks in her area, and it, too, is welcoming the Community union’s coffee mornings. I urge both my colleagues to attend one of those to share experience and listen.
Almost 80% of menopausal women are in work, with most planning to work for many more years. However, three quarters report that they are considering reducing their hours and one in four are giving up their jobs because they are finding it too difficult to balance their work life with their symptoms. Our careers should not stop when our periods stop. Whether our jobs are physically or mentally demanding, small adjustments could make all the difference. My hope is that employers listening to this debate will make those adjustments and take pride in the fact that they are menopause-friendly workplaces.

Richard Holden: This is a great cause. The hon. Lady and I are working together on various other issues as well, and she is a doughty champion for cross-party working on so many  important issues. Will she comment briefly on how small employers can help? As one myself, I have two superb women, Alison and Deborah, who work in my constituency office and they have made me very aware of the issue that is being raised in the House today.
Will the hon. Lady also comment on the “Better for women” report by the Royal College of Obstetricians and Gynaecologists, which has worked with me closely on the hymenoplasty and virginity testing changes that it is bringing forward? Will she say a bit more about those workplace policies, particularly to help small employers understand how they can better support women? The team is so important to small employers, and the individual members all contribute so much at different parts of their lives.

Carolyn Harris: What I would say to the hon. Gentleman is that communication is key here; you cannot provide if you do not know what is needed. Do not be embarrassed and do not shy away from that conversation. If staff members do not feel comfortable talking to one person about it, find someone they will talk to. It is so important that you ask them what they need, not tell them what you are prepared to do. Communication and adaptation to suit the individual is key.

Seema Malhotra: I, too, just want to pick up on the point that my hon. Friend made about women and the workplace. We know that, according to the Centre for Ageing Better, 800,000 people over 50 were wanting to work more and were under-employed—that was the case a year ago, at least. Does she agree—

Eleanor Laing: Order. The hon. Lady has already had one intervention, which was very long. I allowed that, but her second intervention is heading towards being very long and I cannot construct this debate like that. About 30 people wish to speak this morning. I am sure that the promoter of the Bill wants to make sure that as many people as possible get to speak, but that she also will not want to talk out her Bill. I hope that those who support the Bill will not make long interventions and long speeches, because otherwise the Bill will be talked out and we will not achieve the result we are intending to achieve. So I ask for brevity, please, on all sides.

Carolyn Harris: Thank you, Madam Deputy Speaker. May I suggest that my hon. Friend and I have a conversation outside the Chamber, where we can expand on what she is seeking to establish?
As women reach this stage in their lives, understanding their own bodies and having support in all areas of their lives is crucial, but it is clear that we have a long way to go. That is why the Bill calls on the Secretary of State to lay before Parliament a United Kingdom, cross-party, cross-Government strategy on menopause support and services that will incorporate all the areas I have spoken about.

John Lamont: I congratulate the hon. Lady on all her work on the Bill. My question is about the UK-wide aspect. Clause 1 applies only to England—prescriptions are free in Scotland—but clause 2 applies across the entirety of the United Kingdom. There is a duty to consult  Scottish Ministers. If the policy area is devolved to the Scottish Parliament, how will those discussions work in practice? What would happen if Scottish Ministers did not agree with the strategy agreed by the UK Minister?

Carolyn Harris: I am going to leave that to the Minister to worry about. I am sure that the Scottish Government do not want me telling them what to do. I would be happy to have a go. If only I was on the Government Benches, then I would get it sorted.
I am not just asking the Secretary of State to do this. I want to work with him, his Ministers and colleagues from across the House to build a taskforce that will take on these issues and find the solutions, because I truly believe that, working together, we can change this—even in Scotland, if necessary.
We also desperately need to look at prescription charges for HRT in England and at what we can do to ensure that the cost is not a barrier to women accessing it. The menopause does not discriminate, so the cost to treat it should not either. There are women struggling to find almost £20 a month, and that just is not right when it is a time in life that women will reach. There is no avoiding the menopause for half the population. Most women will spend at least a third of their lives perimenopausal, post-menopausal or—the joy—menopausal. We must ensure that those women who need it are not denied HRT because of financial restraints.

Dehenna Davison: Like everyone else in the House, I thank the hon. Lady for her vociferous campaigning on this really important issue. Assuming that we get there and manage to abolish prescription charges for HRT in England, how does she perceive us running a good communication strategy so that women are still not put off because they do not know that prescription charges have been removed?

Carolyn Harris: I am sure that the Minister will enlighten us on that issue. That is the issue: whatever we do today, it has to be communicated to the wider population so that they understand our commitment to their health.
The biggest complaint I have received over the past few months is from women who need both oestrogen and progesterone. Women who have had a hysterectomy can take oestrogen on its own, but everyone else needs both. Despite the two hormones being combined into one product, women are charged individually for the hormones, meaning that each prescription costs them £18.70, and with 86% of women getting only three months’ supply each time, the costs begin to add up.

Danny Kruger: The hon. Lady is being very good about giving way—I am very grateful to her. On the question of cost, I was struck by what she said earlier about her own really difficult experience of being prescribed antidepressants because she was not properly diagnosed with the menopause. I chair the all-party parliamentary group on prescribed drug dependence. She might be aware that last week Dr James Davies of Oxford University published research showing that the NHS currently spends half a billion pounds a year on unnecessary prescriptions of habit-forming drugs. Will she join me in raising serious concerns about that, and does she agree that we must press the Government to review properly the prescriptions of dependence-forming drugs?

Carolyn Harris: I certainly do agree. We have all heard stories about chemists getting back a skip-full of drugs after people have passed away. It is wrong—I totally agree.
That leads me to the next issue: the National Institute for Health and Care Excellence guidelines, which recommend following a three-month trial period. Women are then prescribed HRT on an annual basis. I appreciate that that may not be possible for a small number of women, but from looking into this it is clear to me that that very rarely happens, so women continue to be charged each month, against the advice of the public body. It is clear that that has been overlooked for far too long, leaving far too many women in England either without the vital treatment they need or worrying each month about how they are going to find the money to pay for it. That is why the Bill calls on the Government to do something about it—to find a way to stop women in England being disadvantaged because of the cost of HRT prescriptions. Nothing will have a greater impact on such a huge proportion of society, especially those who are at a socioeconomic disadvantage.
Everyone has a part to play in this revolution—women themselves, educators, medical professionals, families, friends, employers—but it is to start here, in this place, today. For the 13 million women in the UK who are currently either perimenopausal or menopausal, and for all those women who follow, we need a commitment that things are going to change.
It was pointed out to me last week that, according to Hansard, since 1803 “menopause” has only been referenced in Parliament a mere 197 times. I think over the last two weeks I have probably been able to double that single-handedly. Changing the history of Hansard will be some achievement, but making history for menopause will be far more important to the women in this country.
I would like to thank everyone in this place, around the country and indeed across the globe who has been in touch to support this Bill. It has been quite overwhelming, and it is great to see everyone in the Chamber today with their “Menopause Warriors” badges, because this is a revolution for all those whose lives have been or will be impacted by the menopause. The dictionary definition of a revolution is the forcible overthrow of a Government in favour of a new system. Although I do not have time for that today—[Interruption]—not today; it has been a busy two weeks—there are women in Parliament Square today who are expecting us, as those they elected to this place, to do something for them and to do right by them.
Let us join the likes of Tudor Lodge surgery, Timpson and the Balance app as examples of best practice in tackling stigma and the symptoms of the menopause. I urge the Government to work with me to make HRT accessible to everyone, regardless of financial constraints; to ensure that women are diagnosed at their first appointment and get the treatment they need; and to educate everyone, so that those who are experiencing symptoms get the support and understanding they need in every aspect of their lives.

Robin Millar: I associate myself with the comments of others and with their praise for the hon. Lady for raising awareness of this issue. Would she be willing to include in the Bill’s provisions those women who will experience a chemically-induced menopause? They will experience the menopause more than once, and sometimes even three times, in their lifetimes.

Carolyn Harris: My revolution intends to help every woman who is experiencing the phenomenon, in whatever capacity, be they 13 years of age—I have heard about some women as young 13—or in their 80s. It does not discriminate, and I want to make sure we do our best for every woman. Our daughters and all those who come after them will have each one of us here today to thank for ensuring that we make progress and that the menopause revolution continues. We cannot let them down. Now is the time to do the right thing and to make sure that women across this country have all the support, guidance and reassurance they need to overcome their menopause.
I believe that the Government are listening. The Minister herself said in this Chamber just last week that the Government are putting the menopause at the top of the women’s health strategy. I believe that today will be the start of putting right the historical injustice that women have experienced, and that 2021 was the year that the menopause revolution was born.

Jackie Doyle-Price: It is a great pleasure to follow the hon. Member for Swansea East (Carolyn Harris), who has given a tour de force presentation of her Bill. She brings her characteristic charm and leadership with which she approaches all her campaigns. I am sure that when she was drawn at No. 3 in the private Members’ Bill ballot, the Government gave a collective intake of breath and thought, “Oh, my goodness! What is she going to bring in?” She has used that position to bring forward a Bill on a very important subject, which, as she says, affects 51% of the nation’s population. I am hugely grateful to her, not least because I have been banging on about exactly these subjects myself for a while. She is quite right when she says that there has been barely any reference to this debate or these issues in Hansard. Dare I say it, but that is because for a long time there just were not enough women in this place.

Thangam Debbonaire: I thank the hon. Lady for giving way on that point, because this point was burning inside me while I listened to my hon. Friend the Member for Swansea East (Carolyn Harris) making her fantastic speech. Does the hon. Lady agree that this debate is one of the benefits of a truly diverse Parliament? Any time anybody asks us why it matters that there are more women in Parliament, here we have it—this debate would not have happened without more women being in Parliament, with all of our diverse experiences, alongside our male allies. Does she agree?

Jackie Doyle-Price: I could not possibly disagree with that. The really sad thing is that it has taken a century of women having the vote to get to a critical mass where we can now finally discuss these things. I hope that we will make up for lost time. This Bill is a very important one.
One of the most important things that this Bill will achieve is that society will start taking these subjects seriously. There is so much about women’s health that has been taboo for a very long time. I have spoken a lot previously about problem periods, and about the fact that endometriosis continues to go undiagnosed, causing massive problems for women and girls who suffer with it. It says everything. Again, one in three women suffer fibroids. We all think that it is normal. We all think that this is what a woman’s lot is, and we are encouraged to suffer in silence, and it really should not be that way.  It is interesting to make that observation in the wake of the Cumberlege report, “First Do No Harm”, which, obviously, looked at these issues from the perspective of vaginal mesh.
Over and over again, we see the same issues raised. Women are not heard. The quality of conversations that women have with their medical practitioners is just not good enough. Too often, women feel fobbed off. That struck me when I was a Minister in the Department of Health and Social Care. A number of female colleagues would share with me their experiences. I just thought, “For goodness’ sake, we are pushy, opinionated women who are elected to this House! If we are not being heard, then God help the rest of the female population.” It is really important that we shine light on what can be expected. As the hon. Member for Swansea East so eloquently explained, presenting to a GP with symptoms, which ended up with her being sent away with a prescription for anti-depressants for something that all women will go through just is not good enough. I cannot believe that we are still having this conversation. The more that society in general understands what comes with menopause, the more that we will be able to have those sensible conversations and the more that we will be able to manage our conditions well. We must acknowledge this throughout society. We have to start in schools and make sure that everyone understands the life course around women’s health and what they will go through.

Sara Britcliffe: I thank my hon. Friend for giving way and the hon. Member for Swansea East (Carolyn Harris) for bringing this Bill forward. On educating people, one of the first times that I actually understood this issue was as a result of this Bill, so it is key for women and men to learn about the subject at a young age so that we can go forward.

Jackie Doyle-Price: My hon. Friend puts that extremely well. The fact of the matter is that, even as women who are well-informed and interested in this subject, we still do not necessarily know what to expect. It is also the case that boys and men need to understand these things too.
Hon. Members will know that I chair the all-party pharmacy group and I can advise the House that the National Pharmacy Association is fully in support of this Bill. It fully supports the exemption of HRT from prescription charges. It also expressed its willingness to play a much bigger role in terms of the education and support of women going through menopause. We know that, a lot of the time, the conversations that patients can have with their pharmacists are less intimidating and less formal than those they might have with their GP. Again, lots of things are available over the counter that can help alleviate the symptoms of menopause, but also a lot of advice can be given about generally looking after wellbeing. I say to the Minister that I know that pharmaceutical bodies will be very keen to play their role in making sure that there is a much wider understanding and in giving more support to women going through the menopause.
My hon. Friend the Member for Devizes (Danny Kruger) raised the important issue of the half a billion pounds of potential waste of prescriptions. We must make better  use of pharmacists to review prescriptions, because they often tend to know more about the drugs that are being dispensed than thfe GPs who are writing the prescriptions. If we can play a better role in enabling pharmacists to review the prescriptions that their patients are presenting to them, we might go a long way to making those savings and getting more bang for our buck from the billions of pounds that we spend on our NHS. I encourage the Minister to look constructively at that suggestion, because the issue of misdiagnosis and the cost of drugs is significant.
The hon. Member for Swansea East has raised the issue of vaginal dryness. That leads me to make the observation that if we had applied as much attention to vaginal atrophy as we had to erectile dysfunction, we would be much better off—wouldn’t we? I cannot help but come to the conclusion that if this were happening to men, we might be in a better place. Look at what happened when Viagra was invented: within a year, it became available over the counter. That really begs the question of whether women are being treated fairly in this context. It does not feel like it to me. Again, I am sure that the Minister will be quite sympathetic to that point.
I ask the Government to look constructively at that issue, because we could liberate some of these drugs and make them more available over the counter. We have recently made the mini-pill available over the counter, which is really important given that one in three pregnancies is unplanned, and increasingly those unplanned pregnancies are women in their 30s, rather than teenagers. We have got to the right place when it comes to making contraception more available over the counter, but it took an awfully long time—much longer than making Viagra available over the counter. We must take these matters seriously.
On the subject of vaginal atrophy, I pay tribute to my constituent Sue Moxley. Sue used to be the beauty editor of The Sun. She is now better known for being the singing partner of her husband, David Van Day. She has spoken very publicly about her issues with vaginal atrophy. Again, she echoed the point that it happened to her completely unexpectedly. She was not prepared for it at all and it was incredibly difficult for her to find out information about what she was going through. In the end, having had a number of referrals, she experienced a direct laser-based treatment from Italy to improve the supply of collagen to the vagina, and it was transformational. I ask the Minister to look at that treatment. It is a direct physical treatment; it will not suit everybody, but neither does HRT. We have to ensure that we have a diverse range of treatments available, depending on people’s conditions, because, as the hon. Lady mentioned, everyone’s experience of menopause is very different.
One other issue that Sue raised with me was that it was suggested to her that women who have not experienced childbirth tend to suffer menopause worse. That raises another question, because if that is true, women should all know about it. There is lots about our life courses and experiences that will impact our health, but I would suggest that not enough research is being done into these things. For 51% of the population, I think we deserve better, so I encourage the Minister to look at that.
I have a few final points. The hon. Lady mentioned that HRT has had a bad press. A study in—I think—2001 suggested an increased risk of breast cancer as a consequence of HRT. In fact, that increase was very small, and the impact that study has had on women’s  wellbeing has been far more damaging. Let us look at what goes on further through life. If more women were encouraged to take HRT, there would be massive savings for the Government. When we look at social care and why people go into residential care towards the end of their lives, we see that one of the biggest causes is falls and frailty. If we could encourage more women to take HRT—if it suits them—we would have fewer problems with osteoporosis and the injuries that lead to it. It makes perfect sense—we are spending to save.

Tom Randall: I join my hon. Friend in her congratulations to the hon. Member for Swansea East (Carolyn Harris). It was Teresa Gorman who said:
“HRT keeps you out of hospital, out of an old folks’ home and out of the divorce courts.”
Does she agree that it is surprising that one third of women who visited a GP were not made aware of HRT, and that greater awareness of it will help improve women’s health?

Jackie Doyle-Price: My hon. Friend puts the point so well: it is incredible that so long after the former hon. Member for Billericay was making her campaign, we have not moved on—we have almost stalled. However, the hon. Member for Swansea East is turbocharging it so that we can make up for lost time. From a Government perspective, it is frankly a false economy not to make HRT more widely available.
The hon. Lady made the crucial point that there is not enough training of medical professionals about these issues, either. That must be addressed as a matter of urgency. I fully support the Bill and congratulate the hon. Lady and all the campaigners she has worked with to get us to this place. It is clear from the mood in the Chamber that the House is with her, and amen to that! Women are back in charge.

Judith Cummins: It is an honour to speak in the debate. I rise to support the Bill in the name of my hon. Friend the Member for Swansea East (Carolyn Harris), which I proudly put my name to. She has led the campaign on the Bill with her well-known enthusiasm, commitment and integrity. I am sure the whole House will join me in commending her on her approach.

Hon. Members:: Hear, hear!

Judith Cummins: I will speak on one aspect of HRT and menopause: the link with osteoporosis. I do so as the co-chair of the all-party parliamentary group on osteoporosis and bone health. As I have said before, menopause is an important time for bone health. According to the Royal Osteoporosis Society, the decrease in oestrogen levels causes loss of bone density, so the menopause is an important cause of osteoporosis. Everyone loses bone density and strength as they get older, but women lose bone density more rapidly in the years following menopause. With that loss of bone density comes reduced bone strength and a greater risk of breaking bones. One of the many reasons that I support my hon. Friend’s Bill is that it is essential that women are properly supported around the time of menopause not just to assess their risk of osteoporosis and fractures but to be  given appropriate advice and medication, including hormone replacement treatment, which reduces bone loss and the risk of fractures.
HRT is available only on prescription, and currently those accessing it are charged every time. That must change. The Bill’s provisions would be incredibly effective for the majority of women who take HRT. A recent survey of 1,000 women by Newson Health found: just one in five do not receive HRT as a repeat prescription; 86% receive a prescription for three months or less at a time; and 20% spend more than £150 on their NHS HRT prescriptions each year. The Bill’s provisions would create a useful cost saving for so many women accessing this important treatment.
Importantly, the Bill would also legislate for menopause for the first time and revolutionise how those who go through menopause are treated. Access to HRT must be widened to tackle misconceptions and ensure that those going through menopause can access the hormones to protect their bones and ease their experiences. Better education is needed in schools and for healthcare professionals to ensure that menopause symptoms are easily recognised and not misdiagnosed, as my hon. Friend and many others have said.
I am proud not just to help break the silence on the silent disease of osteoporosis but to break the taboo on talking about menopause, which is shrouded in mystery for many despite affecting over half the population at some point in their life. I support this Bill, which would undoubtedly help so many women to keep their bones safe and well.

Caroline Nokes: It is always a privilege to be in this Chamber to support the work of the hon. Member for Swansea East (Carolyn Harris). It is just over a week since we last debated the menopause in the Chamber, and I always say that in Parliament we should pick not just our battles but our allies. It is a pleasure to campaign, to hold a revolution and to be a warrior alongside her.
The reality is that all women will go through the menopause, but not all women will suffer symptoms. Only about 80% suffer symptoms and HRT—a brilliant, wonderful solution to some of those symptoms—does not work for everyone, and the same type of HRT does not work for every woman. That is why it is often a case of trial and error, going through many prescriptions to find the form of HRT that works for each woman and resolves their symptoms. We have to address the costs because women will be bearing the burden of prescription after prescription until they find the solution for them.
We have heard a little this morning about education, but no one has yet paid tribute to the brilliant work of my right hon. Friend the Member for East Hampshire (Damian Hinds), who made sure that, as part of personal, social, health and economic education, girls are not just taught about periods, not getting pregnant and contraception but are taught about what might happen when those periods stop. Of course, it is not just a matter for girls. Their male classmates and colleagues, their fathers and brothers, also need to be part of this discussion.
As we have heard repeatedly, there is too little knowledge in schools and in the workplace. I regard this place as a workplace and, until very recently, it was heavily male-   dominated, but we are clawing it back, sometimes just one seat at a time. I pay tribute to the work of one of the foremost menopause warriors, Anne Milton, the predecessor of my hon. Friend the Member for Guildford (Angela Richardson). As Deputy Chief Whip, Anne Milton played the crucial pastoral, human resources role of helping many of us with conversations on all sorts of weird and wonderful health issues. It helped that she was previously a nurse, but she was an evangelist for HRT. When I spoke to her about it yesterday, she said, “Just go and get yourself a prescription, because this will solve those hot flushes at night and the fact you wake up in a puddle of sweat.” I still tried to say, “No, I’m sure that’s just my insistence on sleeping under a 13.5 tog duvet.” Apparently not.
I vividly remember being brutally asked by GB News, “What are your menopause symptoms?” I recoiled a little from the question, which I thought was a bit rude. And then I thought, no, I have to talk about it. I regard it as my duty to talk about it so that younger women know, whether it is brain fog, anxiety, hot flushes or night sweats, this is all normal and it can be addressed.

Angela Richardson: I had that conversation with my predecessor, the right hon. Anne Milton, quite a few years ago, and she completely changed my mind about HRT. My mother and aunt had to go through this 30 years before me—I am now 47—and they had difficult reactions to HRT. My aunt died from cancer that, anecdotally, was blamed on HRT.
It was Anne Milton who said to me, in a frank conversation, “This is what women need to live good lives.” I pay tribute to her for having the courage to have that conversation with me, and I pay tribute to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for the courage she shows in talking about it, too.

Caroline Nokes: My hon. Friend has made the point—lead good lives—and that is what we want to do, whether it is at home or at work.
Something in particular has struck me during Menopause Awareness Month. I have spoken to many employers about the menopause workplace pledge, and have talked to members of organisations in the City of London about what they can do to support women. According to a survey carried out by the Fawcett Society, 50% of women working in financial services were not taking on additional responsibilities because they were worried about their menopause symptoms, while 25% were considering leaving work. Women at the height of their careers are potentially losing them, and not providing those brilliant female role models to which we all need to aspire in order to progress in our careers.
I make no criticism of my right hon. Friend the Member for Pudsey (Stuart Andrew), the current Deputy Chief Whip, but I issue a plea to all those in the Whips Office: make sure you have good, strong women in there who can provide advice when it is needed. I pay tribute to Claire Hattrick, who lives in Hampshire and runs the clipboardclaire.com website, providing impartial, informed advice for women when they are going through the menopause. Many of us simply do not know what the symptoms are. We do not understand them, and we do  not know where to turn. Claire and many like her across the country provide that advice, free of charge and independently, giving us all hope that the symptoms can be dealt with.
Bills such as this mean that we will debate the issue on the Floor of the House as well as in the wider country. It is about having the conversations, about making sure that we understand, and, most of all, about joining the hon. Member for Swansea East and ensuring that we are all warriors and allies, and that we are going to bring about change.

Liz Kendall: It is a privilege to speak in the debate, and to follow the right hon. Member for Romsey and Southampton North (Caroline Nokes) and the other Members who have spoken so far. I think that by speaking out about the menopause, Members on both sides of the House, women and men, will be giving a voice to 13 million menopausal and perimenopausal women in the country whose needs have been downplayed or ignored for too long.
I must begin by paying tribute to my hon. Friend the Member for Swansea East (Carolyn Harris), a phenomenal campaigner who is working across party lines, and with organisations up and down the country, to push this agenda, make a practical difference to women’s lives, and get the job done. I am very proud to stand alongside her today.
I feel that at this point I should make a personal declaration of interest in this topic, as many of my colleagues have already done today. To be honest, I am not really sure when the symptoms first started, but they have been building steadily over the last year—the truly terrifying sense of anxiety and panic that I had never experienced before; feeling completely exhausted, sore and aching all over, wondering in the evenings if I could make it up the stairs to go to bed, let alone do the exercise that has always been such an important part of my life; the itching, the hair loss, and just feeling downright low; and above all, what I can only describe as the catastrophically bad sleep, night after night. I would finally emerge in the morning drenched with sweat, thinking, “How on earth am I going to make it through the day?”
Like so many other women, I had absolutely no idea what was going on. I thought that there could be reasons for each of those symptoms individually, but together they felt overwhelming. 1t was only when a friend of mine recommended that I check out the MegsMenopause website that the penny finally dropped. This was something real, something really was happening, it had a name, and there was something that I could do about it that might start gradually getting the old me back.

Jackie Doyle-Price: I thank the hon. Lady for being so honest and open about this. She has just said that she did not know what was happening to her. Given that she is an intelligent, well-informed woman, does that not illustrate the importance of better education about this condition?

Liz Kendall: Absolutely. I must be honest: I was in a quandary about whether I was going to say anything today, but, like the hon. Lady, I thought, “If we in this  place, with the power, influence and authority that we have, are too nervous to speak out, what does that say? “ We need to be leaders and champions, and I hope that we are all making a small contribution to that today.
I must say that I have had a very good experience with my GP. Two weeks ago, I did an online survey. A few days later, I had a phone consultation and I got my first HRT prescription last week—ironically, on the same day as the Backbench Business debate on World Menopause Awareness Month—but I know that millions of other women are nowhere near as lucky. Almost one in 10 women have to see their GP more than 10 times before they get proper help and advice. Two thirds of women suffering low mood or anxiety, like my hon. Friend the Member for Swansea East, are wrongly given antidepressants instead of HRT, often for many years. Around one in three women will end up having a hip fracture due to osteoporosis unless they take HRT, as was rightly mentioned by my hon. Friend the Member for Bradford South (Judith Cummins).
The objectives at the heart of this Bill—to raise awareness of the menopause, to make it easier for women to access HRT and to improve the education and training of health professionals—are absolutely essential. I hope when the Minister rises to speak, she will set out the steps her Government will take to make these goals a reality, because frankly, getting women the right diagnosis and the right treatment at the right time is a no-brainer. It is better for women and it is better for the taxpayer, because it will stop women having to have lots of unnecessary doctor’s appointments. It will stop them being put on the wrong medicines for years, leaving the real issue untreated and undiagnosed, and it will reduce the likelihood of women getting conditions such as osteoporosis when they do not need to, which can lead to much more serious and expensive NHS care, such as hip and other operations.
There is lots more I could say on that issue, but I want to use the remaining time I have to talk about the impact of menopause in the workplace, an issue rightly raised and championed by the right hon. Member for Romsey and Southampton North. There are currently more than 4.3 million working women aged 50 to 64. We are the fastest growing group in the UK workforce, often at the peak of our experience, with all the skills and talent that that brings, but 80% of women say that the menopause has affected their working lives.
Around 14 million days are lost at work every year due to menopause, and a quarter of menopausal women at work find the symptoms so debilitating that they are considering reducing their hours, changing their working patterns or leaving the workplace altogether. Women lose their income and careers, businesses lose their talent and the Treasury loses their taxes. Where on earth is the sense in that?
The fundamental problem is that the vast majority of women are too embarrassed, worried or frightened to speak out or discuss the issue with their bosses or line managers. I think the reason for that is the double whammy of sexism and ageism. If a quarter of men in their 50s were considering quitting work or reducing their hours, you can bet your bottom dollar that it would be at the top of the workplace agenda and a solution would pretty quickly be found. Women should not have to suffer in silence. We have to remove the ignorance and stigma about the menopause. It is not a women’s  issue or a private matter, let alone a joking matter; it is a mainstream, no excuses, no ifs or buts workplace issue, and it must be addressed. Again, I hope when the Minister rises, she will set out the steps her Government intend to take on this vital issue.
In conclusion, Members will know that I have never been one for revolutions, but on this issue I make an exception.

Sajid Javid: I think every word that the hon. Lady has said will resonate with millions of people across the country for exactly the reasons she set out. It is powerful to hear from her about her personal experience, and I hope, especially after this day and going forward, that the whole House can co-operate and do much to help with this. I welcome her comments.

Liz Kendall: That is very kind of the right hon. Gentleman, and very much appreciated by me, my colleagues and women across the country. I am very proud to join my hon. Friend the Member for Swansea East, all the other women and men in the Chamber today, women outside this place and the organisations who are campaigning on the issue and calling for a menopause revolution. As she said on the radio this morning, let us make women wonderful again. Who on earth could disagree with that? Millions of women across the country deserve nothing less.

Nickie Aiken: Is it me or is it warm in here? That is one of the issues we have to raise to get rid of the taboo of the menopause. How many of us have gone around saying that most days in the last few years?
I welcome the Bill of the hon. Member for Swansea East (Carolyn Harris). As a fellow Welsh woman, I know that no one should ever mess with a Welsh woman. I thank her for the support that she has given me since I arrived in this place. One of the first conversations we had was when I said to her, “I’m having a nightmare menopause. I don’t know what to do.” Since, she has been a great support to me and I have missed our menopausal women exercise classes on a Tuesday; we need to bring them back.
It is a serious and timely debate—the second on the menopause during Menopause Awareness Month, which is an achievement in itself. It is time for us—men and women—to talk about the menopause. As I have said before, my hon. Friends the Members for Totnes (Anthony Mangnall), for Eastleigh (Paul Holmes), and for Hazel Grove (Mr Wragg) have been supportive in talking about it to me personally, which makes a huge difference to us women. We have to do more of that. I also pay tribute to the Health Secretary who spoke earlier. I spoke to him last week and earlier today. He absolutely supports our wish to break down the taboos of the menopause and do more for women.
From my experience, GPs need better training on the menopause. I went to my GP several times before I could access HRT, and even then, it took six months to get access to an HRT clinic. In that time, I felt so alone, because HRT would work at some times in the month, but at other times it would not. I came off it after a year,  but the symptoms became so bad again that I felt I had to go back on it. I have been fortunate that it has worked the second time, but the menopause can be a very lonely place, which is why there needs to be more education for GPs.
There also needs to be more education in the workplace. The hon. Member for Swansea East is right to say that we need to discuss the menopause in the workplace. As the Member for the City of London, I pledge to do all I can with the financial services industry to ensure that it takes it seriously.

Ben Everitt: I join all hon. Members in thanking the hon. Member for Swansea East (Carolyn Harris) for bringing the subject to our attention and for bringing the Bill to the House. I thank my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) for the workplace education that I am receiving today on this important issue. I hope that she agrees that we need to talk about it more openly, and today’s debate is a good place to start.

Nickie Aiken: My hon. Friend makes several good points. This is a good workplace in which to bring the menopause to the forefront.
We have to start a public health campaign on the menopause. We have to ensure that it is not just women in their late 40s and early 50s who understand it but women who are younger who will reach it eventually and men. It is important that our partners, our sons and our daughters understand what we are going through. I pay tribute to my wonderful husband Alex who has been so supportive of me in the last three or four years. As we all know, it can be hell for us and for those around us.
Turning quickly to prescription charges, as I raised in the House last week—I have discussed this with the Secretary of State for Health and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield)—I think the NICE guidelines are very clear. However, we have to make sure that GPs are aware that, after the first three months of a woman being on HRT, they can put us on an annual prescription, which would be £18.70, or whatever, once a year. If we could really ensure that GPs understood that, it would be a saving of about £200. That would make a huge difference to women, and I declare an interest because I obviously pay for my own prescriptions.
Finally, I again thank the hon. Member for Swansea East for introducing this. I thank the celebrities—Davina, Penny and Meg—and all the other brilliant women, and also sites such as pausitivity.co.uk, with brilliant women who are really bringing Know Your Menopause to the front. People should get on that website and learn as much as they can about the menopause. I am part of the MenoRevolution, and I am absolutely proud to be a menopause warrior.

Nick Smith: What a brilliant and important debate we have had today on women’s health. It has been fantastic, has it not? I want to pay tribute to my butty, my hon. Friend the Member for Swansea East (Carolyn Harris). She has done some fantastic campaigning on this issue.
I would like to look at the issue of menopause and employment. About 14 million workdays are lost each year in the UK due to the menopause. A TUC survey found that nearly nine in 10 women say it has affected their working life. How a woman experiences the menopause in work can be dramatically shaped by what her employer does. Here is one story from a woman called Barbara, who spoke to the Wellbeing of Women charity. She said:
“My memory was shot to pieces… I felt hot and sweaty all the time… I didn’t want to speak up in meetings for fear of”
embarrassment about how she looked. She also said:
“Overnight, I felt I’d lost all my confidence in my ability to do my job.”
When Barbara went to her employer, she thought it said the right things, but did not understand what support was needed. There are too many stories like this. About 900,000 women have left their jobs because of the menopause. Something has to be done.
Some women have more severe symptoms than others, which is why employers must be proactive and flexible. As my hon. Friend said, a tick-box exercise will not work. This is why organisations such as the Wales TUC have produced fantastic resources for union reps to give advice on what they can do. There are already some companies doing good stuff. Santander has started training managers to better understand the menopause, and places such as Sainsbury’s have brought together colleagues to tackle this topic, while HSBC has introduced menopause champions to encourage more conversations at work.
It is fantastic that more and more women are speaking about the menopause. When Andrea McLean shared her experiences on “Loose Women”, she said that
“within 24 hours, 10,000 women got in touch”.
Workplace wellbeing for women needs a helping hand today. We must send a message to employers that they need to put menopause policies and support in place, and to do it now. We all need to play our part so that women like Barbara are given the respect and the dignity they deserve. Parliament needs to support this important Bill today.

Selaine Saxby: It is a privilege to be speaking in this debate. I too pay tribute to and thank the hon. Member for Swansea East (Carolyn Harris) for her work in this area and for allowing all of us to speak. I also echo the thoughts of my hon. Friend the Member for Thurrock (Jackie Doyle-Price) about how it has actually taken having this number of women in the House to enable us to have such conversations. When I first went into politics, I was advised not to talk about women’s issues, but if we do not talk about women’s issues, who else is going to?
This very much highlights the message, which I have referenced before, that we are far more united and have far more in common than that which divides us—the words of the fallen Jo Cox. This is also for friends of mine, such as my schoolfriend Fiona, who has given up work after 24 years as a civil engineer because she cannot manage her perimenopausal symptoms. What is the point in encouraging these fabulous women to go into science, technology, engineering and maths professions if we lose them 15 years before the time they should be retiring? It is vital that we talk about and emphasise  this, and that we learn about it. I am fortunate in having feisty friends who have told their doctors during lockdown that they have the menopause and will be having HRT, but not every woman is prepared to take on their GP in that way, so I also want to highlight concerns around those women who have self-diagnosed and need their GPs to open their doors. I recognise that GPs have been under huge duress and done fantastic work during the pandemic, but women would like to see them again. We would like to have our blood pressure taken by our doctor in the surgery rather than get a friend to do it over dinner because they happen to be a nurse; I would love to say I am making that up but I am aware of women who have been on HRT for several years now and who have not seen their GP at all or had their blood pressure checked. It is important that we get back in touch with our doctors, have these conversations, and ensure we are on the right treatment to tackle the symptoms, because we quietly hide so many of them and are, perhaps, not aware. The shadow Minister the hon. Member for Leicester West (Liz Kendall) gave a moving description and I hope many women are listening today and say, “Ah, I wonder if that’s what’s going on” rather than just brushing it under the carpet as so many of us do so that we can get on with our busy lives.
I hope today’s debate also serves as an opportunity to tackle the issue of our having busy lives because, as well as the cost of having a prescription every three months, for those of us with busy lives there is also the hassle of having to contact the doctor’s surgery. Those surgeries are also very busy and would probably rather not hear from us every three months to get that repeat prescription, which then has to go back to the pharmacist, who also has a busy life. It would be fantastic if we could agree on the treatment and move forward.
I know that many Members want to speak so I have kept my comments brief. I am grateful for the opportunity to contribute and I hope the Minister will build on this menopausal momentum and prioritise changes in this area.

Peter Dowd: These are some of the words of my hon. Friend the Member for Swansea East (Carolyn Harris) when she launched the all-party group on menopause:
“I’m determined to change the woeful support offered to women…This menopause revolution will bring an end to women’s suffering.”
She also said:
“I know that we can deliver legislation that will make a real difference to women’s lives.”
I commend my hon. Friend on those words and, more importantly, her determination to put them into action by introducing this Bill. I hope to be just one of the many hon. Members who help her achieve her aim to
“bring an end to women’s suffering.”
My hon. Friend is well aware that this Bill is just the start of the process. It is a foundation for much of the rest of the work that has to follow. It is the beginning of a process that will take a great deal of time, effort, endeavour and resource. This House can help in that challenging process by supporting the Bill, and the Government can also help by supporting it.
We are not short of experience, evidence and real-life stories of the impact and effect perimenopause and the menopause can have on women. They are not statistics on a spreadsheet. Those women are our wives, mothers, daughters, aunties, sisters, nieces, friends, colleagues, and constituents.
Millions of women will need the support of everyone in this House to ensure that they get what they are entitled to: not indulgence, but that which is their right. They have a right to live a life that is not bedevilled by the vicissitudes of the menopause or exacerbated through ignorance, lack of support, the unspoken—“let’s not talk about it” approach—that we have seen on this issue for so long. They have a right to a life free from the impacts of the menopause such as anxiety, depression, tiredness and the myriad other challenges women face, many outlined by hon. Members today.
Last week my hon. Friend the Member for Bradford South (Judith Cummins) rightly raised the issue of osteoporosis in the debate on menopause and she rightly did so again today. She highlighted the link between the menopause and osteoporosis.
I want to touch on three areas to reinforce what Members have said today. In the first instance, the primary aim of the Bill relates to prescription charges. This is a major anomaly that my hon. Friend the Member for Swansea East has raised time and again. It cannot be right that this crucial health support is out of synch on prescription charges when compared to other forms of non-charging for prescriptions. For example, the hon. Member for Thurrock (Jackie Doyle-Price) referred to erectile dysfunction and issues around contraception. This is all the more important when the impact menopause has on women for years, and the deleterious knock-on effect it has on family life and work life for so many women and their families, is clear.
Secondly, as I alluded to earlier, this is just the start of a process, not the end or the fulfilment of a process. There needs to be a reappraisal of the training given to clinicians both pre-qualification and post-qualification to ensure that this significant health issue, which affects millions of women to one degree or another, is given the priority it deserves. It is not an attempt to point the finger at hard-working and in many cases overworked clinicians, as others have said; it is an attempt to recognise that women have been ignored, not understood and passed over, and that other issues around their perceived health have not been linked to the menopause when they should have been.
Thirdly, I want to make a suggestion. Given that it is patently obvious that women go through the menopause with varying degrees of intensity and impact on their health, what about a menopause health check for women starting at the perimenopausal stage and into the menopausal phase? From the evidence of the all-party parliamentary group on menopause we know that many women themselves were unaware of the symptoms linked to menopause. NICE guidance setting out an holistic approach to support for woman during both phases would be welcome, as the current guidance is not necessarily as comprehensive as it could be. The last guidance was updated in 2019, as far as I can tell. Perhaps a more substantive refresh would be appropriate.
In conclusion, the impact of the menopause on so many women—an impact often hidden, misunderstood, neglected, ignored and misunderstood—really does need  a thorough reappraisal, not just in a narrow or focused medical way but with a cultural sea change in attitudes to the menopause and its impacts. Some of them are life changing and they need to be dealt with right across society in schools, health services and workplaces.
I believe the Bill goes some way to address some of the issues we are debating today, but as my hon. Friend the Member for Swansea East said, nothing short of a menopause revolution will suffice to address this challenge, which is not going away. As a vice-chair of the all-party parliamentary group on menopause and a co-sponsor of the Bill, and as someone who has been conscripted into it, not necessarily as a warrior—[Laughter.]—I exhort Members to support it. The Government and Members right across the House can play their part by supporting my hon. Friend’s endeavours. I support the Bill and I really do implore everybody to do so.

Ben Spencer: I join Members from across the House in paying tribute to the hon. Member for Swansea East (Carolyn Harris) for bringing forward this very important debate and for the campaign she has been running.
I have a different experience of the issue. Obviously, I have not been through the menopause, but as a doctor working in mental health I have looked after several women who have come to me where their depression has been misdiagnosed as the menopause. So I have seen the issue the other way around. I completely get the point that has been made across the House by several Members that understanding and recognition in this area by clinicians is something that people have many concerns about and needs to be improved. One thing that I have really taken notice of is the strength of feeling around that and the medical profession needs to think about that. I should make some declarations. I am still a member of the medical profession. I am a member of the Royal College of Physicians and the Royal College of Psychiatrists, but, as I would say if I was a member of the Scientific Advisory Group for Emergencies, I am here speaking in a personal capacity today.
I want to talk about one of the statistics that has been put out, which is that 41% of medical schools do not have formal training on the menopause. I found that astounding—I had formal training on the menopause when I went to medical school—so it is worth unpicking that a little bit. I had a look in the briefing to see where that came from. My reading of it is that it is not that student doctors and GPs are not getting training; they are getting training. They are getting vocational training on placements with senior doctors who are teaching them, but some schools do not have formal modules in terms of didactic sit-down teaching on it. I think we need to be a little careful when we say there is no training on the menopause and to dig in a little bit. The reason that is important—as I say, I totally get the sentiment and agree on the need for improvement and better recognition —is that we need to be careful about issuing diktats for how the profession approaches its training programmes. If we carve off something for one disorder, the question then is, “Well, what about other things?” Eventually, the strength of the argument will start to diminish, because we will have all different campaign groups saying, “This needs to be separately cut out, and this, and this.”

Carolyn Harris: Can I just say, 51% of the population is a huge amount of people who are not getting appropriate care.

Ben Spencer: I thank the hon. Member for her intervention and for pointing that out, but I would argue that it is maybe not 51% of the population who are in that situation of needing that care and support. Although 51% will go through the menopause, that is different from saying that 51% of the population will therefore need medical intervention and medical discussions around this.
But like I say, I do not particularly want to get into a deep debate on this; I just wonder whether we could ask the profession what it thinks it can do better, rather than us telling it, top-down. Of course, I would say that, I am a doctor—yadda, yadda, yadda; declarations, etc.—but I just wonder what the profession would say in response to the hon. Member’s campaign about how it can improve things and whether we can hear a bit more about that.
My final point is that, in a sense, I find the fact that we are having to have today’s debate deeply depressing. It is a wider indictment of the problems we have in society with the role and position of women. We have got the Equality Act 2010 and lots of legislation and statute, but as we have heard, when it comes to cultures and attitudes, it is just not there. There really needs to be a step change, given the events of the past year and what we have seen with sexual harassment. I have loads of constituents who come to me and tell me about the disrespect experienced by women. I hear the points made by my hon. Friend the Member for Thurrock (Jackie Doyle-Price). It is frankly appalling that women’s health has been left behind. We need to think carefully about what we can do as leaders of our communities and society to change things and increase respect for girls and women and the position of women in society. On that note, I absolutely pay tribute to the hon. Member for Swansea East for bringing this debate forward and the campaign she is running.

Rachel Hopkins: This debate, which my hon. Friend the Member for Swansea East (Carolyn Harris) has brought forward, is so important, and leadership starts here, so I declare an interest as a perimenopausal woman.
I just remembered to say that, though, because the brain fog was good this morning when I woke up. We have talked about how many times we want the word “menopause” to be mentioned in this Chamber. I will try to say it a number of times to help my hon. Friend to up the count, but I also want to say the word “spatula”, because I could not remember what it was called, and that is when I first started to google “memory loss” and “dementia”. When I started forgetting words for things—I knew what they were, but I could not remember—I thought there was something wrong and I might be getting early onset dementia. We sort of chuckle, but when I started mentioning it to other female friends, they just said, “Oh, that’s just brain fog. You know it’s linked to the menopause?”
I wanted to raise a number of points that have already been raised about misdiagnosis—we have heard that 41% of medical schools offer no mandatory menopause  training. I also wanted to talk about workplaces, which have no legal requirement to have menopause policies or to protect employees experiencing menopausal symptoms. However, when I mentioned this debate in my WhatsApp group on my 40-minute train journey into Parliament this morning, I got more lived experience in those 40 minutes. So I am going to put down my speech and read out some of the responses I received:
“Please talk about the fear of dementia. I am so struggling with brain fog now and know now that I need to go on HRT but so many women struggle with postcode lottery with HRT.”
“Great to see such an important topic being discussed with such importance. Ironically I’ve got my call with the doctor today about HRT.”
“One symptom I didn’t think I mentioned—paranoia. I convinced myself that my husband was having an affair for about seven months.”
“Feeling inadequate at work when I have been doing this for decades. I have days where I can’t seem to find clarity or lift my mood.”
“If my GP tried to put me on antidepressants, I would list all the life experiences I have had without them and insist on a second opinion. I feel strongly that we need to treat the cause, not the symptoms.”
“I have had three years of worrying myself sick that I have cancer. Numerous unpleasant, stressful and invasive tests, and only now, when I ask, ‘Could all these symptoms be menopause’ do they think. Numerous GPs, a urologist and a gynaecologist. FFS.”
“I might mention how I’ve knackered my Achilles tendon. That’s a likely consequence of the menopause because tendons are affected due to lack of oestrogen.”
And we have heard about osteoporosis.
In one of her final comments, a friend says:
“My long-term strategy is education for the medical professionals and society. We are literally provided with sex ed, but it stops at that. Too many women feel lucky if their doctor knows their stuff on this. The amount of women who leave employment because they aren’t coping with symptoms. We are financially, physically and emotionally demonised because of a hormone deficit. I am seriously considering leaving work.”
Another friend says:
“I know at times of stress I often think about leaving work, but so many women are taking early retirement or reducing their hours, not because they want to but because they think they’ve lost it. Menopause needs a myriad of support beyond HRT.”
The final comment:
“My workplace is more likely to put a cabbage wrestling on our meeting schedule rather than some open, frank discussions surrounding this.”
I just want to say, for Trish, Sarah, Caz, Liz and Helena, and for women around our country: viva the menopause revolution.

Flick Drummond: May I also add my thanks to the hon. Member for Swansea East (Carolyn Harris) for this amazing debate and Bill?
When I was first in Parliament, I encountered the exact experiences in all the comments read out by the hon. Member for Luton South (Rachel Hopkins). I was incredibly worried about it. I am delighted that so many people are now speaking out about it in public, because none of that was happening when I was first in Parliament and going through the menopause myself. Other than knowing that hot flushes were part of the process, I had no idea about any of the other symptoms until I listened to “Woman’s Hour” in, I think, 2017 and literally  everything became clear: the brain fog, the insomnia, which I am afraid has not gone away—it was in the middle of the night that I heard the programme—and the anxiety and weepiness and feeling that you couldn’t cope with what was happening to you. That was very much part of it. Weight gain is common in Westminster anyway, and a lot of men also gain the Westminster stone, so I cannot blame the menopause for that, but it is certainly something that we need to work on.
That is why this conversation is so important. There are 5.1 million women aged between 45 and 55, and it is estimated that 1.5 million will be going through the menopause at any one time, yet we are so embarrassed to talk about it. Husbands and partners are at a loss as to why their wives and partners are struggling, because the symptoms have been hidden from public knowledge. If I had known some of the symptoms before, I could have dealt with them better, and I am sure my husband could have as well. That “Woman’s Hour” programme was a saviour for me, because suddenly I understood what was happening, and if you understand what is happening, you are better able to face it.
Turning to HRT, I never take medication, apart from the odd pain killer, so taking something to control a natural process was something that I did not consider—probably mostly from ignorance, I should add—but I completely understand that others need medical help. The House of Commons Library briefing states that
“16,000 women were admitted to hospital in England in 2019/20 with conditions associated with the menopause.”
I had absolutely no idea, and I am sure that most of the public do not either.
The case on HRT has been well made, so I will not say more on that, but I do hope that we can consider how it can be made affordable, because, otherwise, it will become a postcode lottery. I am very grateful that a Member who represents a constituency in Wales is interested in looking after all of us who live in England.
I wish to comment on the second part of the Bill, because it is very important. I am really pleased that everything has been raised so publicly, but it is extraordinary that it is only in the past four years that people have been bold enough to speak out, when this has been happening to millions of women for centuries. The big change is that more women are in the workplace now than at any time over the past 100 years, and nearly half of all women are over 50. I am really pleased that we have the menopause workplace pledge, with so many employers leading the way. I hope that Parliament has signed up to it, too. Flexible working hours are essential, especially as lack of sleep is a big issue. Another thought is allowing women to come later into work if they travel on public transport, so that they do not have to crowd themselves in when they are feeling incredibly hot. I have come off the tube so many times absolutely drenched in sweat and incredibly embarrassed that I do not have a change of clothes when I get to my office.
The point about training GPs is crucial, too. I listened to what my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) had to say. I spoke to a doctor about this and found that the issue is barely covered in their initial medical training. For GPs, the clue is in the name—the name is general practice, which means that GPs have to cover a huge area in their curriculum, and it is not mandatory to have additional  training for a condition such as the menopause in their professional development. I would very much like to see such training being seen as part of their professional development and it should be taken perhaps every year or every few years, so that they can keep up to date with every aspect, whether it be HRT or anything else on the menopause.

Ben Spencer: Does my hon. Friend hope that the chair of the Royal College of General Practitioners is listening to this debate today and responds to the hon. Member for Swansea East (Carolyn Harris) on what we are talking about on GP training?

Flick Drummond: Absolutely, because it is incredibly important that people understand what we are going through—whether we are talking about men or women or people of any age. As someone who does not see the same doctor twice in their practice, although I have not been there very often, I do not have that relationship with a GP, so I would feel embarrassed about going to ask for something that I did not know much about.
On the peer-to-peer point, when I returned to Parliament in 2019, I looked around at the new intake and started approaching women of a certain age—I call them my WOCA group—to form a support group to help those going through the menopause. This has been a lifeline to us, and I hope that everyone else considers that as well. [Interruption.] I can see Madam Deputy Speaker indicating to me.
Finally, may I thank the hon. Member for Swansea East. She truly is a force of nature and I congratulate her on all the things that she is achieving in Parliament, and it is such a joy to work with someone on the Opposition Benches to make a real difference to people’s lives.

Paula Barker: I start by reflecting on the importance of these sitting Fridays. They are full of noble pursuits, with hon. Members trying their utmost to leave their small stamp on the world.
To my hon. Friend the Member for Swansea East (Carolyn Harris), whether it is this Bill today, or measures on gambling machines, school holiday hunger and child funeral costs, she always champions the right and just causes, using her voice in this place to elevate the voices of those who feel that they have been long forgotten. I congratulate her and thank her for the support that she has always given me.
Madam Deputy Speaker, perhaps this will come as a surprise to you, as it will, I hope, to everyone in this place today, that I, too, am a woman of a certain age. The challenges that women face in this place are great. Many women may be starting families or raising young families and I can only imagine how difficult that must be.
I was first elected in December 2019, not long ago, and my two sons were of high school age. I had avoided such challenges, but new ones presented themselves. I want to briefly share a little of my personal experience. A number of years ago, I had a blood test and went to get my results. I was told by the GP quite incredulously, “You are in your 40s and peri-menopausal.” A few weeks  ago, I contacted the GP to ask for a referral to the women’s hospital in Liverpool to go to the menopause clinic. He asked me why. I said that I wanted to discuss HRT. He said, “We can prescribe HRT.” I replied, “I was told I had to discuss that with the nurse, and last time I discussed my symptoms with her, she prescribed anti-depressants to me when I wasn’t depressed. I also asked her how long I needed to take the medication for. She told me, ‘Forever’.”
That story is not unique; it is the story of so many women. Whether it is brain fog or migraines, whether it is hot flashes—which I have suffered incredibly from all morning—weight gain or overwhelming tiredness, as a perimenopausal women, I know all these signs and symptoms to be true and real, and I appreciate the toll that it can take on physical and mental health.
Despite my challenges, I know how lucky we in this place are. The challenges that perimenopausal and menopausal women must negotiate in the workplace are many and sometimes complex. Many co-workers simply do not understand bosses and shift managers concerned at the drop in productivity, the changes in mood and the need for time off, given the irregular periods, bladder problems and much else besides. There are no warning signs, and no timeframe is set out by our bodies, which are all unique and respond very differently.
As my hon. Friend the Member for Swansea East set out so eloquently with her Bill, we should abolish prescription charges for HRT right away, and what is so evidently lacking is a national conversation on the menopause. That is why clause 2 is so important.

Gerald Jones: I congratulate my hon. Friend the Member for Swansea East (Carolyn Harris) on her campaign, which she has delivered in her inimitable and passionate style, which we know and love. As well as awareness in medical school and in the workplace, does my hon. Friend the Member for Liverpool, Wavertree (Paula Barker) agree that it is hugely important that we have awareness across society? Until this campaign, my awareness of menopause was shockingly bad and awareness in society, particularly among men, is really important.

Paula Barker: I thank my hon. Friend for his intervention. I was going to say that education and awareness for those of school age right through to GP practices should form the backbone of a new dawn for women, who so often feel alone and frustrated that men around them just do not get it.
Finally, I say to my hon. Friend the Member for Swansea East: “From one sister to another, I stand with you today and with every woman out there who needs to know that someone, somewhere has got their back.”

David Simmonds: Time is very much against us, but I particularly welcome this debate and especially the decision by the International Menopause Society to adopt bone health as its theme for this year. I pay particular tribute to Councillor Janet Gardner of the London Borough of Hillingdon, who has been very public in talking about the impact of osteoporosis. Having people in public life who are willing to talk about that, to demonstrate how they can continue to serve the public, is incredibly important when we discuss these issues.
The Bill’s scope is extensive and, in the short time open to me, I will focus particularly on the lessons that we can learn from public health campaigns, as well as on the points raised by the hon. Member for Swansea East (Carolyn Harris) about how we turn the aspirations that we all share into transformational change in the way in which women are supported with the symptoms that they may experience and other members of society can engage in providing the help that is needed to access that range of support.
There is an opportunity through the devolution of public health responsibilities to local authorities, which took place in 2013, to ask our local health and wellbeing boards, which play a key role in educating the public about a huge range of different health issues, to take on some of the issues that the hon. Lady raised. In particular, I was struck by the point about a menopause check. Public health bodies are very active in encouraging, for example, parents to take two-year-old children for their health check and adults to access the health check for 40-year-olds. That would be an excellent way of building into public health work an opportunity to raise this discussion and highlight the issues, because it has been striking that so many voices today have said that the key challenge, as with so many different aspects of public health, is ignorance. Not knowing what is happening or how to access treatment and ask good questions remain the biggest barriers to success.
Finally, I encourage the hon. Member for Swansea East and Ministers in responding to think about how we can devise a process that is useful in addressing all the issues that she highlighted, including mental and physical health aspects and the relationship with GPs. We must ensure that local authorities who lead on the work can share best practice so that all women in our society can access excellent services such as those highlighted by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) and no one is forced to suffer in silence.

Maria Caulfield: Once again, I thank the hon. Member for Swansea East (Carolyn Harris) for all her work in raising awareness on the menopause both in the House and publicly. The menopause, for once, has taken centre stage in the press, in Parliament, among the public and, most importantly, among women. The menopause revolution is here.
The menopause is being debated for the second week running, as last week the hon. Lady and my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) secured a general debate to mark World Menopause Month. I believe that this is the first time that the menopause has been debated twice in two weeks. I pay tribute to everyone who has spoken in the debate—both this week and last—including the hon. Members for Pontypridd (Alex Davies-Jones), for Luton South (Rachel Hopkins), for Leicester West (Liz Kendall) and for Liverpool, Wavertree (Paula Barker) as well as my hon. Friends the Members for Stourbridge (Suzanne Webb) for Meon Valley (Mrs Drummond), for Thurrock (Jackie Doyle-Price), for Cities of London and Westminster (Nickie Aiken) and for North Devon (Selaine Saxby). I could go on. Every one of them raised experiences from either their own lives or those of their constituents.
We have heard how important this issue is: it directly impacts 51% of the population, and the effects are wide-ranging and often debilitating. Let us be clear, however, that it also indirectly impacts the remaining 49% of the population. The menopause is everyone’s business. Let me therefore update the House on the work that the Government are doing to break down the taboos and improve menopause care for women. It covers three main areas: healthcare; the workplace; and the women’s health strategy.
On healthcare, we know and have heard many times that people often think the menopause is just a woman’s period stopping and hot flushes starting, but it is so much more than that. There are the night sweats, the fatigue, the unexplained anxiety, the brain fog, the headaches and the insomnia. It is important to break down the taboos surrounding menopause so that women can discuss those symptoms with their healthcare professionals and access high-quality healthcare support.
The NICE guidelines are clear that an individualised approach should be adopted at diagnosis and investigation and in managing the menopause. However, the work carried out earlier this year by the menopause improvement programme found that those guidelines are not being consistently followed, and HRT is often not prescribed despite being a safe and appropriate treatment for most menopausal women. We must ensure that those guidelines are followed.
We have recently made a huge amount of improvement in the workplace. With one in four women in the workplace being menopausal or post-menopausal, it is important that employers create a supportive environment. The Chartered Institute of Personnel and Development, the British Menopause Society and the Faculty of Occupational Medicine among others have provided workplace guidelines, which I encourage all employers to explore. As we heard in the House last week, many employers are starting to lead the way, and I pay tribute to all the businesses that have shown such leadership in the area.
The Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Mid Sussex (Mims Davies), is hosting a roundtable with organisations including the British Chambers of Commerce and the Federation of Small Businesses to improve support for and understanding of the menopause, which will make recommendations to Parliament in November. Flexible working options, whether part-time working or job sharing, go a long way to help women in the workplace. The Government’s consultation on making flexible working the default is currently open, and I urge everyone to respond ahead of the 1 December closing date. The Women and Equalities Committee, chaired by my right hon. Friend the Member for Romsey and Southampton North, is about to hold an inquiry on menopause and the workplace. I look forward to its recommendations.
The NHS is leading the way; with a 77% female workforce, it has many measures in place already. I am pleased to say that the civil service will shortly have a menopause policy in work, to follow the guidelines and support the women in our civil service. I wish briefly to touch on the women’s health strategy, because I mentioned it in the debate last week. It will be published towards the end of the year.[Official Report, 15 November 2021, Vol. 703, c. 1MC.] We had more than 110,000 responses to the consultation earlier in the year, and we found that for those between the ages of 40 to 49 and 50 to 59 the menopause was the key issue, and it will be a priority in the health strategy, when it is published.
This Bill is why we are all here today, and I pay tribute to the hon. Member for Swansea East, because there is no doubt that she has made a difference to women’s lives across the country, with the support of other hon. Members, in all parts of this House. Clause 1 seeks to exempt HRT from NHS prescription charges, which are set out in the National Health Service (Charges for Drugs and Appliances) Regulations 2015. Those regulations apply to England only and are amended annually. They set out the prescription charges payable per drug that is dispensed. The charges apply unless someone is exempt because of age, income or other medical exemption, such as epilepsy. It is common for HRT to be prescribed at relatively short intervals, three-monthly or even monthly, in a minority of cases, and a prescription charge applies each time. As we have heard today, a course of HRT treatment often requires more than two medicines, oestrogen and progesterone, or different preparations—patches, tablets, creams and so on. Sometimes that means that women have to pay two charges, even if these products are supplied in a combination pack or included on the same prescription.
I am pleased to announce that although the Government cannot exempt HRT from prescription charges entirely, we have listened carefully to the argument and, as a result, we will amend the regulations to reduce the costs and improve access to HRT. We will do that by reducing the costs of repeatable prescriptions for HRT for women experiencing menopausal symptoms, so that instead of paying for a repeat prescription every month or every three months, the prescriber can issue a batch of prescriptions for up to 12 months with one signature and one prescription charge. The prescriber will set the interval between the issues of the medicine and the number of times the prescription can be repeated, and of course this will be done on clinical grounds. Repeatable prescriptions can be issued either electronically or on paper.
What that will mean in real terms for women is that where it is clinically appropriate, one prescription charge can be paid per year. For example, where a woman currently takes two hormone treatments, oestrogen and progesterone, and receives a repeatable prescription every month, she pays £18.70 each time, which makes a total of £224 every year. Under the changed system, she would pay just £18.70 each year. That is a saving of £205. [Hon. Members: “Hear, hear!”] I feel like the Chancellor, Madam Deputy Speaker. For a woman currently prescribed HRT on a three-monthly interval, moving to a 12-monthly repeatable prescription will make a saving of £66 a year.[Official Report, 15 November 2021, Vol. 703, c. 2MC.] However, we are going further, as we are also committing to reviewing the double hormone issue. The hon. Lady has made a  compelling case for our taking this further, to reduce the cost of living, because it is important that we look at this clearly. I am happy to take that away to look at it further, working with her and other colleagues, and NHS colleagues, to see what progress we can make on that specific issue.
As has been described so eloquently today, the cost of HRT is not the only issue, which takes us on to clause 2. A UK-wide menopause strategy is tough, because health is a devolved matter, and we heard last week about the Scottish Government’s plans for a women’s health plan to address many of these issues. In England, we have our own women’s health strategy, in which the menopause will be at the top of the priority list. However, I recognise that there is work to be done on medical school training, workforce support, access to HRT and other therapies—and just recognising that the menopause actually exists. So today I commit to establishing a new menopause taskforce, with the hon. Member for Swansea East as a co-chair. The taskforce will encourage faster action and join up the dots across the system to take a coherent approach to improving support for those experiencing the menopause. The hon. Member set out in her speech, and we have heard today, that menopause should not be a partisan issue. I hope that she will accept my invitation to co-chair the new taskforce.
I hope that I have reassured hon. Members across the House of the Government’s commitment to this issue. It was telling that the Secretary of State was here earlier to hear these very issues. The Government are committed to reducing the cost of prescriptions, to introducing a menopause taskforce and to making the menopause a priority in the women’s health strategy. I heard the hon. Member on Radio 4 this morning, saying that the aim is to keep women wonderful. As a Conservative and as Government Minister, I probably should not say this, but: up the revolution!

Carolyn Harris: With the leave of the House, I thank the Minister and the Clerks. Wonderful women—thank you! What has happened today is only the beginning, but we can do such great things together. It is all about looking after women. I have just been told that the Welsh Government have also announced that they will be putting mandatory lessons for young people on the national curriculum, and will be delivering a pathway for menopausal women. The revolution has made a big difference. We are keeping women wonderful. Thank you all for your speeches and your time.
I beg to ask leave to withdraw the motion.

Eleanor Laing: The hon. Lady appears to have achieved her objective.
Motion and Bill, by leave, withdrawn.

Childcare Bill

Second Reading

Matt Rodda: I beg to move, That the Bill be now read a Second time.
Before I start, may I thank the Clerks and the Whips who have helped me to get to this point today? In particular, I thank the Lord Commissioner of Her Majesty’s Treasury, the hon. Member for Castle Point (Rebecca Harris), for her kindness and indulgence over a number of weeks.
I begin by recognising the contribution and hard work of the army of childcare providers in this country. Each day, thousands of families entrust their children to professionals who have dedicated their lives to caring for this nation’s young people. It is a vocation and it can be challenging, but without it we would all be so much worse off as a country.
The impact of the coronavirus pandemic and the necessary measures taken to keep us all safe have had a huge impact on children, and we now have an opportunity to work even harder to make up for the time that has been lost. We will all have seen in our constituencies the childcare providers who went all out to support the children of key workers. They put themselves in the frontline to keep our country going, while ensuring that children could continue their early years learning, even in the most stressful and difficult of situations.
I want every family in Reading, Caversham, Woodley and the whole United Kingdom to have the best possible start in life when it comes to their own childcare arrangements. I know that all Members of the House share that wish. We all want every young person to have the best possible start, and we all want to bring an end to the inequality that results from where someone is born, which can, even before their first birthday, shape their opportunities in life.
As the Chancellor of the Exchequer said in the Budget on Wednesday,
“the first 1,001 days of a child’s life are the most important.”—[Official Report, 27 October 2021; Vol. 702, c. 277.]
I genuinely welcome the announcement of investment in early years provision that the Chancellor made this week. It is clear that he and I, and I believe the whole House, share a view that we must level up childcare and early years provision in this country to support our children, support their families and, ultimately, support our economy. All the evidence shows that children who access early years education go on to achieve so much more.
This short Bill is entirely complementary to those Budget commitments and the House’s shared aspiration for our country’s children, and I will explain why. I will focus on three areas: first, the importance of a good start in the early years; secondly, the current system and where there is room for improvement; and thirdly, why it should be a national conversation and why we should have a serious debate about the future childcare system we want.
Every £1 invested in the early years is the equivalent of £8 invested in later education. Imagine any other industry or sector in which a £1 investment produced an £8 return every time—we would all be rushing, cheque  books in hand, to invest. That is exactly what early years provision and childcare do for our children. Along with the love and support of parents and extended families, they provide a balanced and well-rounded introduction to life, which in turn reduces the cost to the country later. Every £1 invested gives children the skills and confidence that they need to learn, grow and thrive. It is what I wanted for my children, and what I want now for the nation’s children.
A well-resourced and comprehensive childcare offer in the early years is an engine that can drive social mobility. Early intervention, through early years provision, gives children a greater chance of accessing higher education and of securing apprenticeships. Those interventions really open doors later in life.
Every Member will have visited primary schools in their constituencies and heard from teachers of reception and year 1 classes who tell us that there is a marked difference in the development of children who have been immersed in early years support compared with those who have not. More people are accessing childcare now than a generation ago. The Nuffield Foundation reported that almost all children attend some form of early years education or childcare arrangement before entering school. That is a huge step forward for the country.
My Bill seeks not to amend or change the current provision in any way, but to champion it and to do all we can to ensure that everyone who is entitled to support knows about it and gets what they need. Clause 3 places a new duty on the Secretary of State for Education to prepare a strategy that promotes the availability of childcare and the benefits of early years provision to all eligible parents. As that is a devolved matter in the other nations of the United Kingdom, the Bill relates only to England. It would make the Secretary of State the named champion of childcare in England and it would compel the Department for Education to consider how the whole Government and the wider public sector, together with voluntary and private partners, can support and promote this important sector.
Crucially, the strategy would also have to consider how that information was delivered to parents in disadvantaged groups, which is levelling up. That is important because the research from the sector and think-tanks—I mentioned the Nuffield Foundation, which has done some excellent work on it—suggests that the children who would benefit most from free early years childcare are, sadly, least likely to access it.
According to the Nuffield Foundation, a third of children eligible for the funded two-year-old places are missing out, which is a tragedy. I want those children to access the help and support their families are entitled to, so that they can reach their full potential when they start primary school.

Will Quince: indicated assent.

Matt Rodda: I am grateful for the Minister’s support and I know that he believes passionately in this agenda. Clause 3 seeks to do that by using the power of the Government and of the wider public sector and other partners to promote childcare availability to children who need it most—a modest ask that could make a huge difference to our whole country.
I turn to clause 2—I am approaching the Bill from the bottom up, which may be appropriate in the world of levelling up—which addresses the elephant in the room: what sort of childcare system do we want in this country? Much like clause 3, the clause does not seek to change current provision. I want to be clear about that to all Members present, and I believe we can work consensually on this important matter. I stand here today not to present answers but merely to facilitate a debate, with the support of the Minister and of other colleagues.
Governments of all political parties have been involved in shaping the childcare sector available to families today. From the Sure Start revolution of the last Labour Government to the new family hubs recently announced by the current Government, every Government have left their fingerprints on the sector. I am afraid this has led to a patchwork of provision in which postcodes, rather than local need, may determine services and in which anomalies have unfortunately been allowed to flourish. This does little to close the educational attainment gap, about which I spoke earlier.
Some areas are blessed with maintained nurseries, and Reading is one of those lucky areas. It is a system in which teacher-led provision, maintained by local authorities, provides the early years foundation curriculum in a more formal setting. I pay tribute to the maintained nurseries in my constituency and in other parts of Reading for their excellent work. However, local authority funding is currently challenged and there has been a decline in the number of places available across the country. Some maintained nurseries, luckily not in my area, have closed their doors.
Other communities are fortunate to have well-run provision in the private and voluntary sectors, either independent or linked to a primary school or multi-academy trust. There is a good mix between early years, as a precursor to school, and other long-established community providers that have often cared for successive generations of each family.
Consistency varies across the country and funding arrangements, due to their complexity, can be off-putting. Some two-year-olds may be eligible for free childcare depending on household income or entitlement to certain benefits, such as universal credit or tax credits. People who earn less than £16,000 before tax and are in receipt of tax credits will be eligible for a free place for their two-year-old. If their child is entitled to disability living allowance or personal independence payment, they may also be eligible for a free childcare place at the age of two.
However, everything changes when the child turns three, when all children become eligible for 15 hours of free childcare regardless of whether their parents are working. Working parents may be entitled to an additional 15 hours a week, taking it up to 30 free hours, but these extra hours are available to some other parents depending on household income and circumstances. My description shows how the system is complicated and difficult for parents to understand.
Although the system for three-year-olds does not sound too dissimilar to the arrangements for two-year-olds, I am afraid it is. The eligibility for two-year-olds is aimed at the lowest paid and the unemployed, but the eligibility for the additional 15 hours for three and  four-year-olds is for those who work more than 16 hours a week and who have a household income up to £100,000. This means that the additional hours are disproportionately going to the children of wealthier parents who are in work and whose educational development is less likely to be held back. Unfortunately, this extra money is going to those slightly better off families.
My Bill does not propose changing the thresholds, but clause 2 would require the Secretary of State to appoint an independent person to lead a review of childcare schemes across England.

Duncan Baker: Will the hon. Gentleman give thought to why there is 15 hours of free childcare only in term time, when many people are trying to go back to work and a full-time job requires them to work in the school holidays, too? Why will the Government fund childcare only outside the school holidays?

Matt Rodda: The hon. Gentleman makes an excellent point, and the review I propose would, indeed, cover such issues.

Jonathan Gullis: The hon. Gentleman talks about an independent person. Does he not see the benefit of the Children’s Commissioner? They are already in place and effectively already have that role, or will the independent person be under the Children’s Commissioner?

Matt Rodda: I will go on to make some further suggestions for the type of independent review, and I am grateful for that suggestion on the Children’s Commissioner.
The Bill does not propose changing the system itself, but it would allow the Government to appoint an independent person to lead a review of free childcare schemes in England. I believe this could have the same powerful impact as previous education reviews led by respected figures with cross-party support. I am thinking of—this goes back a bit into history—the Dearing review of A-levels in the 1990s, or the more recent Augar review of higher education funding. Sometimes, getting a fresh perspective can tease out problems and help to construct collaborative and co-operative solutions that are driven by the sector. Clause 2 would bring together, under the leadership of that independent person, providers, parents, research organisations and others that they saw fit, to take a proper look at how we take childcare forward in this century.

Richard Holden: I am particularly interested in this Bill, as a former special adviser at the Department for Education. Clause 2 sets out the different things that the review must consider. Would the hon. Gentleman consider, perhaps in Committee, including the strategy to increase awareness, as set out in clause 3(3)? Some of the most disadvantaged people do not take up the provision that is currently available, so a review could be helpful if it also considered how to better engage those groups with what he is trying to achieve.

Matt Rodda: I am grateful to the hon. Gentleman for that intervention; he makes a thoughtful point. He is absolutely right that there is a connection between raising awareness of this vital sector and the role of the review, and I would be grateful to work with him on that. As a former civil servant in the Department, I am  very aware of the pressures and difficulty of trying to make the most of our ability to communicate with parents and the difficulty of reaching hard-to-reach groups.
The review would seek answers and pragmatic, practical solutions to the challenge that we have discussed today. That is very much what is needed at this stage. It is not just me calling for this; over 13,000 people signed a petition requesting a review. The National Day Nurseries Association has stated that childcare providers want the system to change in order to ensure that it works for all parents. The national day care alliance estimates that the childcare sector is facing other issues, which could also be discussed by the review, such as the potential shortfall of around £2 billion a year in Government funding, which the alliance believes is needed to meet the costs associated with providing free childcare on offer. As a result, nurseries are forced to charge higher costs to fee-paying families to cross-subsidise those eligible for free care. This, I am afraid, is robbing Peter to pay Paul and drives up the cost of childcare for everyone in the country.
Finally, during the recent debate in the Petitions Committee, the hon. Member for Chelmsford (Vicky Ford), the then Minister, said a review would not be appropriate before the comprehensive spending review. We have now had the Budget and the CSR, so I believe the timing is right. I am grateful to the current Minister for engaging. I believe that, as a new Minister, he may have a wonderful opportunity to take this forward. This is the perfect time to look at the system and ask ourselves whether it is the very best it can be.
The Chancellor spoke on Wednesday of moving to a post-covid economy. To support that post-covid economy, we need a post-covid childcare system that underpins and supports as many parents as possible back into work. We need a system that works for parents, providers and the whole country, but most importantly we need to invest in our children. I will work with anyone in this place to ensure that our children are given the best possible start in life.
As I draw my remarks to a close, I would like to spend a moment, with the House’s indulgence, thanking some of those who have so graciously supported this work. This place can be a maze of process and procedure but, with patience and good humour, the Whips and the Clerks are there to help. I again pay tribute not only to the hon. Member for Castle Point (Rebecca Harris), but to the Clerks and other people who have supported me. I also thank the media, including Grazia magazine, which is also campaigning on this issue, and others who are supporting me. I would like to offer my thanks to my hon. Friends the Members for Stretford and Urmston (Kate Green) and for Hampstead and Kilburn (Tulip Siddiq), who have supported my endeavours with this Bill and provided sound advice where it was needed. To the Minister, I say once again that I believe—and I believe that he sees it in this way—that politics does not need to be confrontational. It does not have to be angry, as we have seen in the last few days. We can work together and seek compromise, and find better solutions, precisely because we are working together.
The Minister has been generous with his time, and despite our political differences, he has engaged in constructive debate and discussion. Whatever happens today, I hope that in his contribution he will consider   the good faith that I bring to the Bill, and will feel able—perhaps because of his own experience—to meet me and representatives of the sector to see how we can progress this issue.
I believe that investing in early years education is one of the first duties of Government. It is the right thing to do, and now is the time to do it. I commend the Bill to the House.

Several hon. Members: rose—

Nigel Evans: I think this is the most convivial Friday morning session that I have ever experienced in the 29 years-plus for which I have been an MP. How wonderful! I call Jane Hunt.

Jane Hunt: I congratulate the hon. Member for Reading East (Matt Rodda) on presenting the Bill, and on the good faith in which he brings his ideas to the table.
Balancing childcare with work can be challenging for many parents and guardians across the country, so it is right for the Government to do all that they can to help mitigate those challenges and support working families by helping them with the cost of childcare. I know that the Government take that responsibility very seriously, being one of the most generous providers of childcare in the world. In 2020, £3.6 billion was provided for the provision of 30 hours of free childcare for three to four-year-olds, as well as an additional 15 hours for disadvantaged two-year-olds. What better example is there of truly levelling up? From the bellfoundry to Barrow in Loughborough, this is an important aspect of childcare and child support. As my hon. Friend the Member for North West Durham (Mr Holden) said in his intervention, we should use today’s debate to promote what is currently available, and encourage our constituents to take advantage of what is already on offer.
In addition to the statutory entitlement of 570 hours of free childcare per year for three to four-year-olds, there are a further 570 hours of funded childcare for which some children may qualify. I know from conversations with local residents that this support makes a huge difference, especially to single parents and those without support networks, as it gives them the opportunity both to make a living and to provide for their families. One resident told me that without the 30 hours of free childcare, the couple could afford to send their son to nursery for only two days a week, but with the additional support he could go there for five days a week. That not only ensures that his parents can pursue their careers, but hugely benefits his mental, academic and social development.
We know that early years provision is crucial to giving every child the best possible start in life, and I want to thank early years providers throughout my constituency for all the work that they do to support families and children—providers such as Watermead Day Nursery in Loughborough, which the Minister was kind enough to visit not long ago; unfortunately I was not able to join him, as I had covid at the time, but I thank him very much for his visit. It is a superb day nursery. There are many other good examples throughout my constituency, but Watermead is incredibly effective in developing those children, and it is a great place to be.
I welcome the support that early year providers have been given over the past year to help them to weather the pandemic, including a business rates holiday, business interruption loans, the furlough scheme and help for the self-employed. This is in addition to the £44 million investment in early years education for 2021-22 announced in the 2020 spending review, as well as the £208 million announced in the Budget on Wednesday which is earmarked for high-quality education, childcare and family services, raising standards and helping parents to work. That will include £170 million by 2024-25 to increase the hourly rate to be paid to early years providers to deliver free childcare offers. Local authorities have of course also been able to increase rates paid to childcare providers for the free childcare entitlement offers by 8p for two-year-olds and, for the vast majority of areas, 6p for three and four-year-olds.
The Bill seeks to make further provision to increase efficiency in the administration of free childcare schemes and to promote the availability of free childcare, including to disadvantaged groups, but it lacks any real substance. For instance, its description of what a review of free childcare schemes should include is too broad, in my opinion, and does not identify any supposed problem areas. It also does not set out what such a review would look like, or what it would seek to achieve. Launching such a wide-ranging review without clear aims is not necessarily a good use of time or resources.
Furthermore, the Government are already taking action to ensure that families, in particular vulnerable low-income families, have access to information, advice and guidance about the support available to them through the establishment of family hubs—I particularly congratulate my hon. Friend the Member for Congleton (Fiona Bruce) and my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who have done a huge amount of work in this area—as well as through the delivery of the action areas set out in the early years healthy development review. With the greatest respect to the hon. Member for Reading East, I feel that he talked frequently in his speech about it being not a challenging but a supporting document, and not proposing change. For those reasons, I am afraid I will not be supporting the Bill today.

Tulip Siddiq: I thank my hon. Friend the Member for Reading East (Matt Rodda) for bringing forward this Bill, and for working so closely on the Bill with me, the shadow Education team and Members across the House, including the hon. Member for Castle Point (Rebecca Harris). I think this is cross-party working at its best, especially on a topic that is so important and so often overlooked. He is truly a champion for working parents and for children whose life chances are going to be shaped by early education and early years education. I also thank all the organisations that have helped him with the Bill and worked so closely with us throughout the process, including the Nuffield Foundation, the Sutton Trust, the National Day Nurseries Association, the Centre for Research in Early Childhood, the Coram Family and Childcare Trust, and the Early Years Alliance.
I will go quickly through the parts of the Bill. First, the Bill addresses a discrepancy between the appeals system for the Government’s schemes for tax-free childcare and free childcare entitlements. The change will allow more disputes to be settled by agreements with HMRC rather than at tribunal, which will save parents time. Any MP with small children sitting in Parliament today, during half-term, will recognise the importance of time. It will save parents time, for anyone who is disputing the Bill, and it will also save taxpayers money. So it is simple fix for a discrete problem and we as a party will support the Bill.
Secondly, the Bill will begin to address the problem, which has been referenced a few times by Conservative Members, that not everyone who is eligible for childcare support is actually accessing it. A Sutton Trust report on the 30 hours free childcare scheme found that this problem came from a lack of awareness among parents and also supply-side issues such as poor availability and the affordability of childcare places in many parts of the country. The Bill would make Ministers look again at how we can promote childcare schemes more effectively so that all families who benefit from the support are able to access it.
It is also clear that the existing childcare support is not sufficient. That brings me to the third substantive part of the Bill, which is a review of the entire childcare system to ensure that it delivers high-quality, value-for-money early education that also enables parents to work. This must be our ultimate goal and I hope, as a Parliament, cross-party, we can work to achieve that. A recent Pregnant Then Screwed survey found that 95% of working parents think that the Government are not helping enough with the cost and availability of childcare. We know from recent research by the Sutton Trust that the 30 hours free childcare offer can often exclude the poorest children, because only 20% of families with earnings in the bottom third of the income distribution qualify.
In no way do I want to ruin the non-confrontational mood of Parliament today, which you have spoken of so highly, Mr Deputy Speaker, but it would be remiss of me to stand here and not mention the fact that the early years sector is currently struggling with a £660 million gap. I hope that we can find the time to review childcare schemes and how they are funded, if we are really serious about addressing early years education and making sure that children, no matter their background or where they were born, get to achieve success in life.
We welcome the Bill as a means of setting us on the path to a better, more sustainable childcare system—one that delivers the high-quality early years childcare that families need, without breaking the bank or the providers. I once again thank my hon. Friend the Member for Reading East for promoting this important Bill.

Joy Morrissey: I congratulate the hon. Member for Reading East (Matt Rodda) on bringing this very important issue to the House, and on taking the bold step of trying to tackle inequality and levelling up, which is what this Bill tries to do.
I worked for the Centre for Social Justice for many years and we looked at the issue of early childhood intervention. Those early years are so crucial to a child’s  outcome for the rest of their life. This Bill shows that the hon. Gentleman cares deeply about inequality and that he wants to make sure that the gaps in society are filled. I thank him for engaging so conscientiously in this process and for seeking cross-Government support, because this is an issue that affects everyone across the UK and it is one of the most difficult issues to tackle.
I support engaging with several Government Departments, not just the Department for Education. My only caveat for the Bill is that perhaps we need cross-Government engagement instead of an independent review. I would love to engage on this issue on a cross-party basis. We need to talk to the Department for Levelling Up, Housing and Communities and the Department for Work and Pensions. Often, really vulnerable families will present to the council rather than their school. They might be too far down the line and it is often a social worker or housing officer at the council who flags up that a child and a family need additional support. How, therefore, do we integrate the approach in all Departments? We need to engage more holistically.
Is there a way in which DWP can ensure that every person on universal credit understands that they qualify for additional childcare if they are at a certain level of work? Oftentimes, if a family are in a vulnerable position and at breaking point, struggling to make ends meet, it is difficult for them to know who to turn to. It might be helpful for all Departments, not just the Department for Education, to be informed about the Government’s childcare offers. Under UC, working parents on a low income may be eligible to receive 80% of their childcare costs. Perhaps not all parents know about that wonderful opportunity.
I am 100% supportive of early intervention for as many children as possible, particularly those in vulnerable circumstances, and I will support the hon. Gentleman however I can. I hope that we can work on a cross-party basis to develop a solution across all Departments. I will be a loud and obnoxious voice as I continue to champion this issue, and I thank him again for raising it.

Dehenna Davison: I thank the hon. Member for Reading East (Matt Rodda) for raising this really important debate. Some issues go way beyond politics, and making sure that our children get the best start in life is absolutely one of them. I am pleased that there is cross-party support for the intention behind his Bill, and I praise the hon. Member for Hampstead and Kilburn (Tulip Siddiq) for her words on that.
Members across the House and people across our country, be they of a political persuasion or otherwise, are committed to ensuring that our children get the best possible start in life. I must praise my hon. Friend the Member for Loughborough (Jane Hunt) for taking us through some of the support schemes that are available and that the Government have put in place. They have made such an enormous difference, not just to working parents, but to parents across the board, giving them the breathing space to know that they can afford that quality childcare and take some time out to do what they need to do outside of looking after their little ones. That is so important. I want to raise one thing from the Budget, which is the £208 million of funding that was announced. That is so important and goes to show how committed the Government are to getting this right.
I am not a parent, so some Members may wonder why I am taking such a strong interest in this particular issue.

Ben Everitt: The House has noted that my hon. Friend does not have any children. I wonder whether she would like to borrow some for the weekend.

Dehenna Davison: Many thanks to my hon. Friend. I am excited to finally get the chance, after covid restrictions, to meet his children later on today, particularly Eliza, who I would quite like to adopt, because she is very much my kind of anarchist. I am not a parent, but I pay tribute to a parent: my mum, who worked in early years for a long time. She worked in a nursery in Sheffield. One of the things I found so moving about my mum’s time there was not just the fact that she always came home from work smiling every day because she enjoyed her job so much, but seeing how much of a personal interest and a personal stake she took in the lives of every one of the children she was looking after. She would come home and there would be stories about what Isla, Elsa and Jake had been doing, and I felt like I knew them. I felt like they were extended members of my family.
I thank my mum for everything she did for the children she was looking after, but I pay tribute to all our early years workers for the excellent work they do. It is hard, messy work. There were always changes of clothes available for all those spills and for some things that were not spilled but also managed to make their way on to parents and those early years workers’ clothes. They are incredible, and I am delighted that, as part of the Budget, there is a commitment to increase the hourly rate for our early years workers. That is so vital to pay tribute and show how much we appreciate the work they do.
Despite her having worked in the field for a number of years, I am not sure even my mum could necessarily run people through the eligibility that different parents have. That is why the point that the hon. Member for Reading East raised about promoting the support that is available is so vital. That is mentioned in clause 3 of the Bill, and I absolutely agree that all of us in this place probably need to get better at it, and not just the Government. Each and every one of us as MPs needs to promote these schemes to our constituents, be it through surgeries, our social media channels or in the media. It is incumbent on us all to help all our parents to know what they are eligible for, and in particular to ensure that those on low incomes know about, have access to and do access the additional 15 hours of funded childcare for eligible two-year-olds. The support is there, so we need to ensure it reaches the people who matter.
I am supportive of the principle behind the Bill, but I believe we should only legislate when legislation is necessary. With that,, I am not sure we need a Bill. We do not need a bit of legislation to go through the House to get this right, because there is a commitment across the board and certainly from Government to look at this, improve promotion and make sure that all our children get that best possible start in life.

Richard Holden: It is a delight to be called in this debate on an important topic. It is something, as I mentioned in my intervention  on the hon. Member for Reading East (Matt Rodda), that I looked at a lot when I was a special adviser in the Department. It is always a pleasure to follow my neighbour and right hon. Friend the Member for Bishop Auckland (Dehenna Davison).

Dehenna Davison: A promotion!

Richard Holden: She should be right hon. She raised a really important point in her tribute to early years teachers. A lot of my family, including both my grandmothers and my mum, were primary school teachers. Those involved in teaching our children and in early years education—particularly over the past 18 months, when so many across the country have faced challenging circumstances—need a shout-out from this place whenever possible.
My hon. Friend the Member for Beaconsfield (Joy Morrissey) raised a particularly important point on the cross-Government approach that is needed. This issue touches so many different areas. Members from all parts of the House have raised the issue of family hubs, which was brought out by my hon. Friend the Member for Congleton (Fiona Bruce) and my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). That holistic approach, working with local government so that families have somewhere to go when in need, is very important. There is a broader requirement here, therefore, going a little further than just early-years childcare for two and three-year-olds: we need to look, too, at shared parental leave. At present far too few men are taking up opportunities to spend more time at home with their children, and perhaps a broader education drive is needed to push that, especially in early years. As more women are in higher-powered careers—a great thing for our country—we can perhaps share some of these responsibilities more broadly.

Tulip Siddiq: My office manager Oliver Denton Lieberman is today going off for a whole year on paternity leave. I want to applaud the fact that more men are doing so; it is good to recognise that.

Richard Holden: I pay tribute to the hon. Lady’s office manager for doing that; it is great to see people leading by example. It has been good to see the Prime Minister taking some proper paternity leave as well in recent years, and Ministers, too. It is still at far too low a level, however, and I think the hon. Lady would agree that we need to promote this more broadly across the board.
The hon. Member for Reading East raised some interesting issues. We need to look at the ratios of staff to children. It seems to me to be iniquitous that for a four-year-old in early years education the ratio has to be 1:8, but for a four-year-old in a school it can be 1:30. Perhaps we can look at childcare more broadly to ensure that it is cost-efficient and can deliver for parents.
I also want to pick up on some of the points made by my hon. Friend the Member for Loughborough (Jane Hunt). One of the great pieces of news in the Budget was the increase in per-hour spending per child. That will go even further if we address those ratios, and it will help improve pay levels in the sector as well. Many of the childcare organisations in my constituency have been telling me that is a real issue, as it is in other sectors such as social care. We want jobs in those sectors  to be seen as high-skilled professions offering careers where people can not just work, but go on and succeed more broadly.
I welcome the cross-party approach of the hon. Member for Reading East; it is exactly the right way to proceed as we share a common view on this matter on both sides of the House, particularly with more parents being in employment. Credit is due to the Government over the last year and a half for the excellent support they have put into the economy to ensure that there are jobs and that vacancy rates are at record highs. Indeed, perhaps this great economic success makes the concerns raised by the hon. Gentleman even more pressing.
However, I agree with my Conservative colleagues that, rather than legislating for a review, the Government could perhaps take this forward without legislation being necessary. I leave that thought with the Minister.

Jonathan Gullis: I congratulate the hon. Member for Reading East (Matt Rodda) on bringing the Bill before the House and on his tone. He is already working across both sets of Benches in the House, and I agree with my hon. Friend the Member for North West Durham (Mr Holden) and many others that this issue touches us all; it is important to every one of us and the conciliatory tone is—as you have said, Mr Deputy Speaker—very welcome, because we want to find a solution. I agree with other Conservative Members in not being able to support the Bill in its current wording, but I support the intention behind it and look forward to working on it with the hon. Member for Reading East.
I have said this quite a few times so I know it will bore some Members on my side of the House, but as a former teacher—[Hon. Members: “Oh!”] I know that comes a surprise to some, but as former teacher this issue is of course important to me. I worked with 11 to 18-year-olds and we would make the point time and again that what we inherited in secondary school was the foundation work set by primary school and even earlier than that, in the early-years sector.
It is probably only in recent years that we have started to take seriously just how important the early years of a child’s education are. I am proud to say that I am the father of a 15-month-old, Amelia, who is at nursery today dressed as a pumpkin for her Halloween party. Having that responsibility of being a father at first hand really does make one conscious of just how important getting that education right is. There are so many well-meaning parents up and down the country who want to do the right thing but perhaps did not come from households where the role modelling was in place for them or do not have support networks on their doorstep because of a lack of transportation, as they do not own a car and there is no good-quality public transport in place to access certain services. It can feel as though they are out of touch or things are out of reach, and that is certainly an issue in the city of Stoke-on-Trent, and in Kidsgrove and Talke. Those areas have poor public transport, with the number of bus journeys having gone down by 10 million in the past decade, meaning that people have lost confidence in that public transport network. Some 30% of people in the city do not even own a car, so how do we make sure we get that support to those parents? That issue is critical.
I wish to praise my hon. Friend the Member for Loughborough (Jane Hunt) for managing to remember all the fantastic things the Government have done in the past decade to support children in the early years. The Budget was extremely supportive, and I was delighted to see the Under-Secretary of State for Education, my hon. Friend the Member for Colchester (Will Quince), tweet and then share this on his Instagram. I am not on Twitter, for the good of my mental health, but I saw there was £560 million for children’s social care homes, which is very important, and £300 million for the Start for Life package, for which my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) and my neighbour, my hon. Friend the Member for Congleton (Fiona Bruce), have rightly been pushing—£80 million of that is going to be for family hubs, and that is superb.
The Minister will be aware that a letter was sent only yesterday from myself and Councillor Dave Evans, the cabinet member for children and families in Stoke-on-Trent, calling for Stoke-on-Trent to be one of the places for those family hubs. We were calling for at least one, Minister, although we are bit greedy and we would like three. The family hubs support children from 0 to 19, as well as offering support to the family. Whether through parenting and childcare support, debt advice or many of the other things available, that is essential. The £5 billion towards catch-up, as we have seen in the primary and secondary school years, and the £150 million for workforce training in respect of the early years is also extremely welcome. When my partner and I dropped Amelia off to nursery, we had the great delight of finding that Miss Angela, one of her teachers, is a former student of my partner, Nkita, at Burlington Danes Academy in London. Although that was a shock, it was a welcome surprise. As my hon. Friend the Member for North West Durham said, we want more people entering that workforce; it is a fantastic career, as they get to shape the lives of so many children.
As other Members have said, the cost of childcare absolutely needs to be looked at as best as we can. I am fortunate to have this job, with the salary that comes with it, and my partner is a senior leader in a school, which comes with a very good salary, one that is well above the national average. Even so, £1,600 a month for childcare five days a week is an awful lot of money. We are lucky that we have that financial security, but this is not an option for many families. So although the 15 hours of free childcare for those on low incomes is absolutely important and we should use this opportunity today to encourage parents to take up that 15 hours, not enough in Stoke-on-Trent are doing so. I urge them today to sign up to that free childcare opportunity and use it to their full advantage, because it should not be thrown away.
The 30 hours of free childcare for working parents is essential and is helping children when they hit three and four, but we have to think about those one and two-year-olds, because it is not right that one parent has to decide whether or not to give up a career in order to stay at home, so as not to have to lose so much of their income to childcare. A look at that would be welcome, although I agree with my Conservative colleagues that we do not need necessarily to legislate for a review. The Children’s Commissioner can pick up the baton today and look into this herself with the powers she has. This could then be fed into the Minister, working with the hon.  Member for Reading East, and then things could be taken forward to see what further strategies could be implemented. That would be a really positive step.
Overall, there is an awful amount being done. Let us not forget the announcement that disappointingly went under the radar a bit on Wednesday: the £200 million a year commitment from the Government for a holiday activities and food programme. That is absolutely welcome. I thank my predecessor, Ruth Smeeth, who was a doughty champion of this issue. She worked with Carol Shanahan, the co-owner of Port Vale football club and the Hubb Foundation, and Adam Yates, a former professional footballer who is now running the Hubb Foundation and is on the Government’s steering group for the holiday activities and food programme.
That programme has not just helped primary and secondary children; it has also created intervention programmes over the school holidays, including the current October half-term, for children in early years. That has been of huge support. It has been done smartly, by using the school building to its full potential, so that there were no additional costs. The programme used facilities that were already in place, that parents trust, and that children feel safe and can be safe in. That was a really good idea.
I congratulate the hon. Member for Reading East for his tireless work on the issue. I am sure that he will have those conversations with the Minister, who I know from first-hand experience is keen always to extend the hand of friendship across the House and find solutions. I hope that we can come to some agreement. Unfortunately, with the current wording of the Bill, I cannot lend the hon. Gentleman my support, but I certainly support his intention.

Angela Richardson: It is always a privilege to follow my hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis)—not to forget Kidsgrove and Talke. And he does talk; he talks with passion and is very knowledgeable about this subject, so it was fantastic to listen to his contribution.
I pay a huge tribute to the hon. Member for Reading East (Matt Rodda). In my former role as Parliamentary Private Secretary in the Department for 19 months, I got to sit in on Westminster Hall debates, in which he participated. I recognise the considered and genuine approach that he brought to all debates on childcare and special educational needs, and I now understand why. I did not realise that he is a former civil servant in the Department for Education. It is great that he can bring that background to his role as a Member of Parliament.
I agree with the hon. Gentleman fundamentally on the importance of funding and investment in early years. My background is working in investment banking, so I am always looking at return on investment. I also looked at it as a parent myself. I decided to stay at home and look after my children. It was really important to me that I could put that investment into them, but I also took the opportunity to put my children into childcare and nursery when they were little, because I recognised its importance for socialisation.
Let me turn to the funding. I was delighted when the Chancellor announced the investment that was going into the first 1,001 days of a child’s life, from birth to  the age of two. I acknowledge the work of my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who has been such a champion on this matter. She has been working on it for such a long time, over a couple of years, with other colleagues in the House. I also pay tribute to my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory), who worked with my right hon. Friend the Member for South Northamptonshire, and thank her for the experience that she brings to the issue.
I was delighted to hear about the investment in family hubs. That is a 2019 general election manifesto commitment and I can really see its value. I was able to visit my maintained nursery in Guildford with the former Children’s Minister, my hon. Friend the Member for Chelmsford (Vicky Ford). It was a fantastic opportunity to see how childcare was being delivered in my community—and in a deprived part of my community as well. What I recognised was the number of children with special educational needs. I thought that the ratio of those children to other children who were attending was quite high. I understood the concerns of the nursery about the funding that it was receiving to be able to manage not just the number of neurotypical children who needed those childcare places, but also the number who had extra needs, which was sometimes quite high. Quite a lot of staff are needed to look after those children.
We also have to look at the structure of nurseries, including the layers of management and the people who are doing all the face-to-face work. Sometimes, we need to ensure that the structure is right so that the children are getting that time and energy, and it is not being put into having to tick boxes, fill in forms and so on. That was a fantastic visit, and I hope that the new Children’s Minister will be able to visit other nurseries in my constituency.
I also pay a huge tribute to nursery teachers. A nursery teacher was instrumental in identifying that my son had additional educational needs and suggested that he needed what is now an education and health care plan—it had a slightly different name all those years ago—and get help with speech and language therapy. The people who go into those roles care so genuinely for young people, and that gives a parent the support that they need.
Clause 3, which would promote the availability of free childcare, is important for families like mine and others who do not have social networks and structures around them. I did not have them because I was an immigrant who had to make all my friends—it was a lonely time being a new mum in a new country—but we also need to address loneliness in other parts of our communities. I hope that in bringing forward the Bill and hearing supportive comments from hon. Members across the House, the hon. Gentleman feels that he has started to have some success in raising awareness, particularly among the disadvantaged groups that he wants to talk to.
I echo the comments of my hon. Friend the Member for Loughborough (Jane Hunt) and recommend that anyone reading my speech goes back to hers, because she listed everything that the Government have been doing. Having worked closely for 19 months in the Department until recently, I saw the care and commitment  of Ministers to children in their early years and to children who are vulnerable. I also echo the comments of my hon. Friend the Member for Stoke-on-Trent North. Childcare is expensive and choices have to be made by people—often women—who ought to be able to carry on with their careers without such a high burden of cost. They should not have to take themselves out of the workforce.
We must also look at the supply side and encourage young people towards childcare when they are looking at their career options, because it is an amazing career and parents such as me value what those people put in. I also encourage men to step forward. The sector has many young women and more mature women in it, but we need men, too. There was a fantastic man in my son’s nursery, and those men can bring role modelling. Let us have a conversation about taking away some of the stigma and making childcare an easier choice for men. It is a worthwhile career. I thank the hon. Member for Reading East for bringing forward the Bill and look forward to working with him, as I am sure everyone in the Chamber does, to realise some of its aims.

Tom Randall: I suppose that usually the menopause follows childcare, but we seem to be doing it the other way round. None the less, I hope that we will find agreement on this subject as we did on the previous one. I join others across the House in congratulating the hon. Member for Reading East (Matt Rodda) on introducing the Bill and making a number of comments that were spot-on. Families are the bedrock of society and of our communities, and he was right to identify the challenges that have occurred recently in particular from children being at home alongside parents who are working from home in difficult jobs.
We must recognise, as I think we have, that society has changed in the last decades and that, whereas in the past it was normal to have a stay-at-home mum, increasingly both parents in a family are working. It is therefore important to reflect that social change in a debate about childcare and its availability. It is important that we also recognise, as the hon. Gentleman generously did, the support that the Government have given to parents, including the £44 million invested in early years education in this financial year, and the other support that was elaborated on by my hon. Friend the Member for Loughborough (Jane Hunt).
I, too, welcome the announcement in the Budget of £14 million for family hubs, which, once set up, will provide expert guidance, advice and advocacy for families. They could make a real difference and I congratulate all those who have campaigned on the issue, including my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) and my hon. Friend the Member for Congleton (Fiona Bruce).
To turn to the detail of the Bill, as other hon. Members have said, I query whether primary legislation is required. Clause 2 calls for a review, which perhaps the Secretary of State could do without the need for primary legislation. Similarly, the establishment of a strategy in clause 3 is laudable but perhaps does not require a new law.
I sensed from the speech of the hon. Member for Reading East, however, that the purpose of the Bill was not to put it on the statute book but to raise awareness of the issues involved, which has been done articulately.  I hope that the Government have listened to his points and I look forward to his argument seeing the light of day in Government policy.

Rob Butler: I am grateful to be called to speak in this important debate. I congratulate the hon. Member for Reading East (Matt Rodda) on the campaign that he has run to emphasise the importance of being able to access the free childcare to which hard-working parents are absolutely entitled. He reminded us of its value, which I am acutely aware of, having been the governor of a primary school and nursery many years ago. The benefit of access to early childcare was made clear to me then.
I will pick up on clause 3 and, I hope, provide some reassurance in terms of awareness. I gently suggest that what the hon. Gentleman is calling for represents duplication, in that a huge amount of information is easily accessible. I will take the opportunity of mentioning it in the House to remind people who watch the debate what is already there. If people search for “free childcare” on Google, Bing or any other search engine, within less than a second the gov.uk site is the first to come up. That takes people to an entire portal designed to assist parents in accessing that childcare.
The portal is clear and easy to understand, and there is even a function where people can enter their postcode to find out their local authority so they get the right information for their area. I am pleased to say that, for Government IT, it does work. I tried it this morning for Aylesbury and I was clearly and correctly directed to the Buckinghamshire Council website and all the necessary facts. Another excellent Government site is called childcarechoices.gov.uk, which is very easy to navigate and attractively set out. Those websites work alongside the plethora of help and support across civil society, including citizens advice bureaux and charities, to make sure that we are well informed.
There is also statutory guidance to local authorities that tells them that they must
“Maintain a service that provides information for parents”,
and that, importantly, says that those who do not have access to the internet must be able to get the information they need about eligibility for free childcare and how to obtain it. I hope that I have highlighted that there are those requirements and that information is available.
The overriding point made by the hon. Member for Reading East is well intentioned. It is incumbent on us all, including MPs, to promote awareness in our local areas. I congratulate him on his work to highlight that availability.

Will Quince: I thank the hon. Member for Reading East (Matt Rodda) for using the opportunity of his private Member’s Bill to bring the important issue of delivering a high-quality, cost-effective and efficient early years system to the House’s attention. I thank all hon. Members for their thoughtful and constructive contributions to the debate.
I know that the hon. Gentleman is representing and championing his constituents in this matter, but that he also has a passion for improving our early years provision  and childcare offer for parents. This is, as he knows, a passion that we share. I have no doubt that he and I will continue to work together in the spirit of collaboration with which he has presented his Bill today.
The hon. Gentleman’s prompt for us to look again at how effectively our childcare system is set up and its benefits communicated to and understood by parents is, I know, very well-intentioned and timely, especially when these issues are currently being made prominent by campaigners. I know that we all have the same aim in doing all we possibly can to make the most of our childcare offer, and I hope that this debate will be the start of an ongoing discussion and dialogue among us on how we can make that happen, including during further debates in this place or, indeed, in Westminster Hall.
As a parent of young children, I know at first hand how important it is to have the right support during those early years. I also know how challenging it can be for parents to juggle their responsibilities—their keenness for their child or children to have the best possible start in life and their obligations to their employment.
As a new Minister, just a handful of weeks into the job, it is important that I look at all aspects of my portfolio and identify not only what is working well, but the challenges and opportunities for improvement. Childcare and early years is no exception. Indeed, the hon. Gentleman already knows that that is, in fact, a priority of mine. There is no question in my mind but that early years education is hugely important in providing an opportunity for young children to develop, and it is an important factor when it comes to breaking the barriers to employment. It will not surprise the hon. Gentleman or the House that I am keen to explore how we can improve our offer.
Turning first to our offer, we have made an unprecedented investment over the past decade and extended access to early education and childcare to millions of children and parents. Our support includes the 15 hours free universal early education per week for all three and four-year-olds. In 2013, that was extended to disadvantaged two-year-olds—those with additional needs and whose parents are on low incomes. In 2017, we doubled our universal 15 hours for three and four-year-olds to 30 hours a week for working parents.
I turn now to other Government childcare offers, which were raised by my hon. Friends the Members for Bishop Auckland (Dehenna Davison), for North West Durham (Mr Holden), for Beaconsfield (Joy Morrissey) and for Guildford (Angela Richardson). Help with childcare costs comes from across Government, including parental leave, support from Her Majesty’s Revenue and Customs via tax-free childcare and from the Department for Work and Pensions, which was referenced by my hon. Friend the Member for Beaconsfield in the form of the childcare element of universal credit.
I appreciate that, at times, the offer across three Departments can appear somewhat fragmented—that was heard across the House—and I am committed to working together across Government to see what we can do to streamline that offer better, to ensure that it delivers most effectively for those parents who access it and is visible to those who need it. All hon. Members across the House can also play their part by working with their local authorities in their constituencies and urging families, particularly those from lower-income backgrounds, to take up the support that is already available to them. My hon. Friend the Member for  North West Durham rightly raised the additional hours for disadvantaged two-year-olds. The take-up is too low and we want to see that rise.
I turn now to funding, which was raised by my hon. Friends the Members for Bishop Auckland, for North West Durham, and for Stoke-on-Trent North (Jonathan Gullis). We have spent more than £3.5 billion in each of the past three years on the Department for Education entitlements. This financial year, as has already been referenced by my hon. Friend the Member for Loughborough (Jane Hunt), we are investing £44 million for local authorities to increase hourly rates paid to childcare providers. We continue to press the importance of the early years sector right across Government, which is why at the spending review on Wednesday we announced that we are investing additional funding for the early years entitlements of £161 million in 2022-23, £182 million in 2023-24 and £170 million in 2024-25.
Let me turn now to covid-19 and recovery. In this debate, I cannot mention childcare without sending all those who work in early years education and childcare my profound thanks for providing an invaluable service to both children and parents, especially throughout the difficult time experienced over the course of the pandemic. It is because of them that children could continue to access that lifeline of social interaction and the early years education that they need. We have recognised the needs of the sector emerging from the pandemic by investing £180 million on education recovery in the early years, to support the youngest children’s learning and development.
Turning to family hubs and points made by my hon. Friends the Members for Loughborough, for North West Durham, for Stoke-on-Trent North, for Guildford and for Gedling (Tom Randall), we are also committed to championing family hubs. Family hubs are a way of joining up locally to improve access to services and the connections between families, professionals and service providers, and putting relationships at the heart of family help. We are already under way with our first £34 million programme. I hear what my hon. Friend the Member for Stoke-on-Trent North said. We have received the letter, although I have to say that there are a lot of colleagues who are very interested in family hubs in their constituencies. I am delighted that at the Budget the Government announced, in line with our manifesto commitment, a further £82 million to create a network of family hubs. That is part of a wider, very exciting £300 million package to transform services for parents and babies, carers and children in half of local authorities across England. Like several hon. Members, I too want to pay tribute to my hon. Friend the Member for Congleton (Fiona Bruce) and in particular my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) for their tireless work in this area.
Turning now to wraparound childcare, alongside our commitment to family hubs and other resources which complement our early years settings, I am so proud of our manifesto commitment to establish a £1 billion fund to help create more high-quality, affordable wraparound childcare, including before and after school, and during the school holidays. Much of that has already been realised in the success—this was referenced by my hon. Friend the Member for Stoke-on-Trent  North—of the £200 million holidays activities and food programme, the extension of which for a further three years was announced in the spending review on Wednesday. But we will not rest on our laurels. My Department is continuing to explore what more can be done to help parents access childcare which will suit them, whether that is out of hours or before or after school.
Turning to maintained nursery schools, an issue raised by the hon. Member for Reading East and other Members across the Chamber, the role played by maintained nursery schools within the early years sector is hugely important. I recognise the hugely valuable contribution those schools make to improving the lives, in particular, of some of our most disadvantaged children. I am pleased that we have been able to confirm continuation of MNS supplementary funding throughout the spending review period, providing the sector with long-term certainty. I am alive to the pressures faced by maintained nursery schools and the local authorities where they operate. Members have already been having long conversations with me and across the Department on what more can done. Those conversations will continue.
Turning specifically to the Bill itself, our determination is strong to improve continuously on our duty to protect and educate the youngest in our society. My Department has already used legislation to great effect to achieve that. The Childcare Act 2016 set out the pathway to 30 hours free childcare, and we have used powers within the Act to extend eligibility for parents whose income has been impacted by the coronavirus pandemic. We are therefore aware of the benefits of securing additional efforts within law, but we also know that such a process can take a great amount of time and resource. As I have already said, the hon. Gentleman’s aims in bringing forward this Childcare Bill are commendable. As well as adding to the Department’s objective of streamlining the application process for 30 hours free childcare, the hon. Gentleman’s Bill seeks to better target families whom he believes will benefit from wider knowledge of the childcare offers currently available. I agree. However, much of what he is intending with the Bill, we already deliver. I have already set out the detail of our funding offer and my intention to work across Government to make our collective offer to parents work more effectively and clearly. We therefore do not think that new legislation is needed to make such improvements at this time.
In conclusion, the early years sector is an integral part of our economy and education, so my Department rightly treats any changes to the system very carefully. The variety, availability and affordability of childcare and early education is something that I, and my Department are very eager to continue, improve and expand. From the introduction of the hon. Gentleman’s Childcare Bill, I can see that that is also very important to him. Affordability and protection for both parent and provider is at the heart of every policy that is developed by this Government for the early years. However, we do not agree that the Bill is an effective use of the House’s time and resources to achieve those aims. I would rather focus our expertise on building on changes we have already forged ahead with. That includes our work on the early years foundation stage, improving the take-up of our tax-free childcare scheme, and, of course, preserving the lifelines that are early years settings as we continue our post-covid economic recovery. I again thank the hon. Gentleman for bringing forward this important  issue for discussion and close by offering him an invitation to talk further with me and my Department on reinforcing and improving our existing efforts, which are, at this moment, the best way of benefiting children and families.

Matt Rodda: With the leave of the House, I beg to withdraw the motion that the Bill be read a Second time. I wholeheartedly thank the Minister for his genuine commitment to this important issue and the way that he has engaged with me. I am extremely grateful to him and look forward to working with him. I listened carefully to his speech and those of others Members. I want to express my thanks and my genuine pleasure in working in a cross-party way. I believe that we as a House have shown something very positive today: that we can work across the House in a thoughtful and measured way to achieve something of great national importance.
I am deeply grateful to everybody who has spoken and for their thoughtful suggestions, which I wholeheartedly agree with. I particularly thank the hon. Member for Beaconsfield (Joy Morrissey) for her point and the hon. Member for North West Durham (Mr Holden) for his knowledgeable points, which showed his experience in the Department, along with the hon. Member for Guildford (Angela Richardson) and many others for their thoughtful and timely points. I look forward to working with the Minister and colleagues across the House on this important matter. I beg to ask leave to withdraw the motion.
Motion and Bill, by leave, withdrawn.

Animals (Penalty Notices) Bill

Second Reading

Andrew Rosindell: I beg to move, That the Bill be read a Second time.
As chairman of the all-party parliamentary group on zoos and aquariums, a former shadow Minister for animal welfare and a committed advocate for the care and protection of animals, I am proud to be given the opportunity to sponsor this Bill. I want to thank all MPs who have co-sponsored my Bill, but there is one MP I want to thank in particular, and that is the greatest advocate for animal welfare I believe this House has ever seen—the man who should have been with Vivienne yesterday as she strutted her stuff around Victoria Gardens and was crowned winner of the 2021 Westminster dog of the year contest, my friend and our dearly missed colleague, Sir David Amess. Had he not been taken from us, he would most certainly have been here today supporting the Bill that I now lay before the House.
As a nation of animal lovers, we must not tolerate those who present a threat to the health and welfare of animals in England, or of course across our United Kingdom. We are proud of our world-leading standards and we continually strive to improve and maintain our position as world leaders in animal welfare. We already have effective, detailed and powerful laws to maintain the health and welfare of our animals, the quality of our animal products and the biosecurity of our nation. However, we lack a system of penalties to redirect behaviour when those with animals in their care are not doing things quite right. We are lacking an option that can sit between warning letters and criminal prosecution. I believe that penalty notices can be the next step in establishing the UK as a world leader in animal health and welfare.
For the most severe crimes, criminal prosecution will always be the most appropriate course of action. We all see the immense value of the Animal Welfare (Sentencing) Act 2021, which my hon. Friend the Member for West Dorset (Chris Loder) so finely championed, in introducing longer prison sentences for heinous animal welfare crimes. I know that every Member in the House would acknowledge that there is a difference between mistakenly logging a farm animal’s movements incorrectly and cruelly, intentionally abusing an animal.
Some offences can occur without the presence of ill will or due to a genuine mistake; for example, transgressions relating to the recording of livestock movements. We have a fantastic farming community in this country, who work extremely hard, around the clock, to properly look after their animals, and they understand the importance of knowing where livestock are and where they have come from.
In 2019, there were 45,000 cattle keepers and 61,000 sheep farmers in England. It is critical that movements are recorded in line with our laws to protect public health, animal welfare and the national herds and flocks. The risk is that, if livestock movements are not recorded accurately, it limits our ability to control and address animal disease. Most farmers record their livestock’s movements accurately and they respond well to advice and guidance from our enforcement authorities.
Unfortunately, however, some farmers continually fail to record accurately, which causes serious risk. This is where I would like to see penalty notices applied in a fair, transparent and proportionate way to positively change behaviours. That would help us to ultimately protect public health, animal welfare and the national herds and flocks. Yet, as I mentioned, the enforcement tools available to deal with such matters are either quite gentle or quite severe. On the quite gentle end of the spectrum, we have advice and guidance, and then, for the most severe offences, we have the option of pursuing imprisonment with unlimited fines. Until now, the cross-compliance scheme has been one of the major means of ensuring that animal health and welfare standards have been met by eligible animal keepers.
Many colleagues will be aware that cross-compliance and the way that it applies subsidy deductions is widely viewed as disproportionate and unfair, particularly by our farming communities. A system of penalty notices, which are financial penalties of up to £5,000, would be fairer and more effective than the EU’s disproportionate and convoluted cross-compliance, and that would extend beyond farm animals into companion animals, zoo animals and animal products.
These proposals would give individuals an opportunity to pay a penalty for any type of transgression, similar to a speeding ticket, as an alternative to a potential court case. We can all agree that, in the most severe cases, this will never be appropriate for those who abuse animals in the worst ways. It does not water down our ability to punish those who abuse animals; it simply provides something in between to deal with less serious transgressions. It will always be appropriate to take criminal prosecution against those who cause and commit the worst crimes against animals. However, where there is an opportunity for us to improve our ability to protect animals from mistreatment by supporting an individual to understand their responsibilities, we will be able to look to apply a penalty.
My Bill establishes powers that will enable us to determine which offences are appropriate through secondary legislation. Under the Bill, penalty notices are applicable for offences under Acts including—to name a few—the Animal Welfare Act 2006, the Animal Health Act 1981, relevant sections of the European Union (Withdrawal) Act 2018, and the Dangerous Dogs Act 1991. I am delighted that by introducing the Bill we are extending much further than cross-compliance was able to achieve, and in a fairer and more transparent way. That will be an animal welfare gain.
With this Bill, we will continue to build our enforcement capabilities, which will further demonstrate our standards in England as world leading. This is a simple measure with a big impact to make sure that we respond proportionately to each transgression, which could include scenarios where pet breeders fail to include their licence numbers on online adverts for puppies and kittens. Businesses that breed animals must have a valid licence: accidentally missing the licence number from an advert or forgetting to microchip the animals before rehoming them can seem inconsequential, but proper registration is critical in ensuring that people can buy pets with confidence from a legitimate source with the high health and welfare standards that they rightly expect. A financial  penalty would be a proportionate response to highlight that these actions are not inconsequential, and would have a real impact on the people who rehome the animals.
The UK zoo sector has among the highest welfare standards in the world, as well as being among the world leaders in conservation work. On behalf of all of us, I thank the British and Irish Association of Zoos and Aquariums for the magnificent work it does all year round in promoting the values of good zoos and aquariums, and for the support it offers to me as chairman of the all-party parliamentary group on zoos and aquariums.
Sadly, however, a small number of zoos do not always live up to our high expectations. When local authorities find an issue, they can put a condition in place. If that condition is not met, a direction may be applied. In many cases, a zoo will respond well to the initial condition and it will improve its behaviour. For those that do not, the local authority may decide to issue a penalty notice, particularly if the condition does not directly link to the care of the animals. I would welcome the addition of penalty notices in this area to provide an additional enforcement tool alongside issuing a direction, to highlight the importance of acting in line with a set condition.
This is a simple Bill consisting of nine clauses. It initially lays out the powers that enforcement authorities will have to issue penalties under the relevant Act, as listed in the Bill. It states that the police will be responsible for applying penalty notices for offences relating to dangerous dogs committed in England and Wales. It explains that penalty notices give a person the opportunity to discharge their liability for the offence, and states that enforcement authorities will have six months to take the case to court if the penalty is not paid after 28 days. It also confirms the maximum penalty of £5,000 —or £2,500 if the penalty is paid within 14 days.
The Bill contains multiple safeguards to ensure that penalties are applied fairly. These include specified factors that enforcement authorities must take into account when considering whether a penalty is appropriate, to ensure that we take a tailored yet consistent approach. There will be official guidance laid before Parliament, which enforcement authorities will need to consider before issuing a penalty. It will be important for the Government to work closely with those that keep animals to ensure that the guidance effectively sets out how penalty notices should be applied.
This Bill sets out the enabling powers to introduce offences through statutory instruments. The majority of the Bill will come into force two months after Royal Assent, with the rest coming into force when relevant secondary legislation is in place. I want to give particular thanks to the organisations from the farming community that have engaged with me on the Bill, including the National Farmers Union, the Livestock Auctioneers’ Association Ltd, the National Pig Association and the Country Land and Business Association. I understand the difficulties that they faced in dealing with the interaction between animal welfare and the common agricultural policy. I am glad that, now we have left the constraints of the European Union, the farming community have shown their support for the fair and proportional penalty notice system in my Bill.
We are very fortunate to have so many organisations dedicated to carrying out important work for animals: Dogs Trust, Battersea, the Royal Society for the Protection  of Animals and the Kennel Club, among many others that do so much for the welfare of pets across our country.
When, as I hope, the Bill is enacted, we will have secured a much-needed framework for a proportionate financial penalty system. Our Government have responded to the people’s will and led the country out of the clutches of the European Union, and that has given us an opportunity—which we must not waste—to improve our standards in many areas, with animal welfare at the very top of our agenda. Today we are continuing to elevate our world-leading reputation for animal health and welfare. The Bill marks an important step in establishing new enforcement in England to ensure that we have an appropriate response to transgressions, so that we can prevent individuals from ever reaching a stage at which severe punishment is required. Today marks the start of the journey of penalty notices to further protect the animals that we are so privileged to have within our care. I thank all Members, on both sides of the House, for giving it their support today.

Darren Henry: I thank my hon. Friend the Member for Romford (Andrew Rosindell) for introducing the Bill. We are a proud nation of animal lovers, and that includes me: my beautiful dog Poppy, a cairn terrier, is often to be seen by my side as I walk around Broxtowe.
The Bill is crucial in ensuring that we stand up for the rights of animals, and that those who do not respect those rights are held to account. It will also ensure that there is no longer a gap in legislation surrounding the prosecution of animal rights offenders, and it contains the necessary legal protections to ensure that it is not misused and is enacted only for the most serious of offences. I therefore agree with my hon. Friend that it will improve the way in which we tackle animal health and welfare offences in the future.

Ruth Edwards: I think it is customary to start by congratulating the Bill’s promoter, but I hope that my hon. Friend the Member for Romford (Andrew Rosindell) will bear with me for one moment while I join him in congratulating Vivienne on her victory in yesterday’s Westminster Dog of the Year contest. I am sure that Sir David Amess would have been extremely proud of her.
My hon. Friend was, of course, right to say that Sir David was one of the leading advocates for animal welfare—but so, of course, is my hon. Friend. I congratulate him hugely on bringing the Bill to the House. I know he has been working on the issue for many years. Thirteen years ago, when we were still in opposition, I was the researcher on the shadow Home Affairs team for my hon. Friend the Member for Reigate (Crispin Blunt). My hon. Friend the Member for Romford had the shadow animal welfare brief and I remember his work on dogs. The other day I was particularly recalling his work on tortoise microchipping because I was pursuing our tortoise Geoffrey across the garden. It is very unfair that tortoises have this reputation for moving slowly, because they do not; they move at incredible speed, especially Geoffrey. He has this determination to try to eat pebbles the size of his head, which would be incredibly  bad for him, so we have to keep an eye on him. Probably a GPS tracker might have been better than a microchip. My husband has suggested a strobe. Any other suggestions are most welcome.
Geoffrey is not the only adventurous animal in our care. We have two donkeys: Sergeant Wilson and Godfrey. [Hon. Members: “Hear, hear!”] Thank you. The other week, I had to extract them from the chicken run. We have two entrances to the chicken run: the little entrance is for the chicken and the big door for the humans. They had managed to open the big door and walk into the run because they wanted to raid the chicken feed. I arrived to find two donkeys guiltily munching in there.
The prize for the best animal adventure has to go to our pig, Andrew. This was when my husband and I lived on his small holding in Wales and Andrew staged a break-out from the new pig pen we had built. Andrew is jet black and he wandered into the maintenance cupboard, trod in a tin of white paint and gave himself a beautiful white sock on one leg. He then trod on the back of a tube of silicone sealant and gave himself a beautiful Santa Claus beard to match his white sock. He then decided to do his bit for the environment. He managed to encounter a bag of recycling, but he did not quite get the hang of it because he proceeded to redistribute that round the farmyard. Then he managed to break into the boot room and get himself shut in the downstairs loo.
However, the penalties in this Bill are not for errant animals; they are for humans who are not treating their animals properly. I am really proud of the work that the Government are doing to protect animal welfare. We have the Animal Welfare (Sentencing) Act 2021, which received Royal Assent earlier this year and raised the maximum prison sentence from six months to five years. We have the new offence for pet abduction, again championed by Members on all sides of the House. The Animal Welfare (Kept Animals) Bill, which had its Second Reading earlier this week, tackles puppy smuggling, the export of live animals for slaughter, and livestock worrying. It expands the definition of animals to include alpacas—our alpacas will be very pleased to hear about that—and includes a ban on keeping primates as pets.
My hon. Friend’s Bill fills an important gap here, toughening sentences for offences that do not qualify for criminal prosecution but that are too serious to receive a warning. I was shocked to hear that the RSPCA received 57,000 complaints of animal cruelty last year. It is so important that we have tougher penalties to tackle that kind of behaviour at a very early stage and, hopefully, to act as an educational tool and to prevent things from getting much worse.
I congratulate my hon. Friend the Member for Romford again. I am pleased to be supporting this Bill and proud that the Government are, too. As I have said before, pets in our house are people, not property. They are our friends, our companions and they deserve nothing less.

Sara Britcliffe: I rise to wholeheartedly welcome the Bill and to pay my tributes to Sir David Amess, who was a great champion. I am so glad that Vivienne did win yesterday.
Pets are more than just pets. At home, they are companions. I see that in my own family. Now that all the children have moved out of the family home, my dad is stuck with three cats: Noodle, who is 21 years  old, Poppy and Macy. We witnessed an attack on Noodle when he was a kitten. He came back to the house after someone, we believe, shot him with a BB Gun, making him lose all movement in his leg, which he now uses as a crutch. We were not able to identify who did that to him, and that is one thing that I hope this Bill will cover. I hope that it will not cover things such as my dad accidentally locking a cat in the fridge—we did manage to get the cat out once we found where the miaowing was coming from.
I welcome the Bill. One of the main issues in my inbox is pet theft and animal cruelty. am so glad that the Government are acting on it, because it is a huge concern for the people of Hyndburn and Haslingden. I wholeheartedly welcome this extra step to protect our animals—our loved ones.

Aaron Bell: It is a pleasure to follow my hon. Friend the Member for Hyndburn (Sara Britcliffe) and also to finally get to speak on a Friday, Mr Deputy Speaker. It has been far too long, for various covid-related reasons, and although I put in for the two earlier debates, they were clearly oversubscribed. These Fridays are such a crucial part of our constitution and the Standing Orders of this House. Our debates today—the debates on the menopause and childcare and now this important debate—show the House at its best. I am really pleased to finally be able to participate on a private Members’ Friday.
It is also a huge pleasure to speak in favour of this Bill, introduced by my hon. Friend the Member for Romford (Andrew Rosindell), who, Members might not know, was my MP two decades ago. When I graduated from university, I moved to Romford to live with friends there for a while, shortly after the 2001 general election. I see that a lot of the 2019 intake are here today. We should remember that this man was the first step on our road back to a majority and back into government, because he gained that seat in 2001, and he did it by campaigning with a Staffordshire bull terrier called Spike, round the streets of Romford in a Union Jack waistcoat.
I pay tribute to my hon. Friend for that and for all that he has done in his career in this place to make animal welfare such a focus. We heard from my hon. Friend the Member for Rushcliffe (Ruth Edwards) about his work in opposition as spokesman, we have this Bill today and he is bringing forward Jasmine’s law to increase tenants’ rights to keep pets in their homes. He has done so much work, including through his role in the APPG.
I congratulate my hon. Friend the Member for Romford, too, on what he did yesterday. We saw the beautiful pictures of him and my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) with Vivienne winning the Westminster dog of the year award, in memory of Sir David Amess. We all feel Sir David’s loss very keenly today, because we know that he would be here, making a speech as funny as, if not funnier than, some of the ones we have heard on these Benches, because he was such an advocate for animal welfare and such a keen advocate of private Members’ Fridays.
This Bill, as others have said, follows the Government’s already landmark legislation on animal welfare sentencing, which increased penalties from six months to five years.  As my hon. Friend said in his opening remarks, the Bill will allow us to match judicial powers more appropriately to the sort of offences we see. We already have the possibility of jail for the most serious offences and we already have situations where it is clearly far more appropriate for people to be given warnings, but there is a lacuna in the middle. This Bill, which has been carefully drafted, addresses that in exactly the right way. It will prevent more cruel mistreatment of pets, zoo animals and livestock.
I know that the Bill has been welcomed by the Government and so many animal charities, and I assume by the Opposition, although we have not heard from them yet. I would gently say that when we have such wide cross-party support for a Bill, it is incumbent on us all as Back Benchers to scrutinise the detail, and I have done that. I have looked at the clauses, and they seem very well drafted to me, so I congratulate my hon. Friend—and, I am sure, the Clerks as well—on that.
However, I am also conscious that we should continue to scrutinise the effects of Bills after they become Acts. As a data maven myself, I therefore particularly welcome clause 6, on reporting. We will very quickly be able see the effects of the Bill through the reports that it requires the Secretary of State to make. I am sure we will do that in the years ahead and hopefully see that it is having the positive effect that I know we all want it to.
As my hon. Friend said, this Bill is fair, transparent and proportionate. Those are the qualities that we want to see in private Members’ legislation. I very much hope that it gets its Second Reading today, and that it goes through Committee and we see it back in this Chamber for Third Reading. By widening the suite of available enforcement tools, it will truly safeguard and strengthen animal health and welfare across the country, which is something that I believe all of us across the House can welcome.

Ben Everitt: I rise to support this commendable Bill, which has come at a fantastic time. In particular, I am very proud to be a Government Member under what I think is the most animal-friendly Government in the history of this country. I am also surrounded by, it appears to me, the most animal-friendly members of that Government, including my hon. Friend the Member for Rushcliffe (Ruth Edwards), whose adventures in animal husbandry seem to have put her in good stead for her current job. Being a PPS is probably incredibly similar to her adventures with Andrew.
I am pleased that farmers will not be unfairly penalised and that the risk of unfairly penalising them will be reduced as a result of these measures. Putting the penalty midway between a caution and the full force of the law seems to be a sensible step to make sure that the mid-range is available to prosecutors. Farmers are possibly the biggest friends that animals have, because it is literally their job to be kind to animals. If they are not, they are doing their job badly. I am not saying that there are not rare cases of that not happening, but in general, I take my hat off to our farmers, particularly those in Milton Keynes North.
I met the fantastic people from Milton Keynes & District Cats Protection recently. We got our cats from there. My hon. Friend the Member for Bishop Auckland  (Dehenna Davison) gave an impromptu shout out to my youngest—my anarchist—so it would be remiss of me not to mention my two cats, Magic and Ninja. We have enjoyed them as lockdown cats over the last year.
Their names are a tribute to my campaigning prowess because I lobbied hard for them to be called Slash and Axl. Unfortunately, I was outnumbered in the household by just four to one. I note that the cats of my hon. Friend the Member for Hyndburn (Sara Britcliffe) came from Cats Protection as well. It was sad to hear that Noodle was shot with a BB gun as a kitten and, frankly, well done to Noodle for making it to 21 years.
Cats Protection wanted to talk to me about the huge increase in airgun attacks on cats in the last few years. It is right to draw awareness to animal welfare and animal cruelty issues, so I commend my hon. Friend the Member for Romford (Andrew Rosindell) for bringing the Bill to the House.
Having mentioned Noodle, I cannot miss the opportunity to mention Peter Britcliffe, who apparently put the cat in the fridge. As the former Mayor of Hyndburn, we always knew that he was a cool cat but apparently that is his hobby as well.
Milton Keynes is a wonderful place but, unfortunately, it struggles with some animal welfare issues, not just the unfortunate airgun incidents that have occurred in the last year. There is also an increasing risk of pet theft, so I am pleased about these measures, which would be a timely addition to our armoury in prosecutions and sentencing.
This week, we launched the Milton Keynes pet theft taskforce. I am pleased to be working with Shazna Muzammil, Police and Crime Commissioner Matthew Barber, my neighbour and hon. Friend the Member for Milton Keynes South (Iain Stewart), and Councillor Alex Walker, who is the leader of the Milton Keynes Conservative group. Pet theft is an animal welfare issue, because people who steal pets will not necessarily be very nice to them, so that tool in our armoury for prosecutions is welcome.
I will end with some statistics. The 2020 RSPCA statistics mentioned by my hon. Friend the Member for Rushcliffe are more up to date than the ones I have, but were potentially affected by the pandemic. In 2019, the RSPCA investigated more than 130,000 complaints of cruelty against animals and secured 1,678 convictions. Any incidence of cruelty against animals is too much, therefore I will be supporting the Bill.

Ben Spencer: It is a pleasure to follow the very powerful and amusing speech by my hon. Friend the Member for Milton Keynes North (Ben Everitt). I will not be able to do anything near as good in the brief moments I will speak for in this debate.
I just want to start by paying tribute to my hon. Friend the Member for Romford (Andrew Rosindell) for bringing forward the Bill, which is very important. We are a nation of animal lovers. Those are not just words. We are not just talking the talk; we are walking the walk in terms of the legislation we have been bringing forward on animal welfare protections. The Bill forms a part of a whole suite of measures that we have been bringing in. I am also an animal lover. We have two cats at home, Ragnar and Frazzle, both of whom are rescue cats.  I suspect that if Frazzle is watching today—I would be amazed if he is—he might have some concerns about the measures being proposed, because he is certainly not an animal lover when it comes to the amount of mice he brings home on a regular basis, so I hope there will be exclusions for cat violence in the legislation.
It is completely right that we have a range of approaches to enforcement and not the very binary approach pointed out by my hon. Friend the Member for Romford. A variety of different measures will help people to do the right thing and support for improved animal welfare will be absolutely superb.
I just want to finish by doing a big shout out to two organisations I have a huge amount of time for. First, the work of Cats Protection in supporting cats and re-homing rescue cats is absolutely brilliant. Secondly, Battersea Dogs and Cats Home, rather confusingly given the name, also has a site in my constituency. I thank it for its work on supporting the welfare of animals.

Daniel Zeichner: I congratulate the hon. Member for Romford (Andrew Rosindell) on bringing forward the Bill. His passion for animal welfare is well known and admired across the House. I also associate myself with all the comments about Sir David Amess. It is absolutely right that he would have been here contributing today. We are so sorry not to have him here with us.
This is very clearly a Government Bill—it was referenced in the Government’s action plan for animal welfare—so I will treat it as such. Some of my comments will be directed as much at the Minister and the Department as at the hon. Member for Romford.
To some extent, this is a puzzling Bill. It is really about penalty notices as much as it is about animals. To see that, one just has to read the long title of the Bill, which is to
“Make provision for and in connection with the giving of penalty notices for certain offences relating to animals and animal products.”
That says to me—I am not a lawyer, but it says it to my legal friends with whom I am consulting—that this is as much about the legal system as it is about animals. I disagree with some of the comments by Government Members. I do not think it is particularly well-drafted. When I first read the Bill my worry was that there was a danger that some of the offences in Labour’s groundbreaking Animal Welfare Act 2006—Labour Members are very, very proud of the 2006 Act—were at risk of being downgraded to the level of a parking ticket.
I listened very closely to the hon. Member for Romford’s speech and I am reassured. I see what he is trying to do. I have also spoken to the Minister and she has reassured me that that is not the aim of the exercise. I welcome the Under-Secretary of State for Environment, Food and Rural Affairs, the hon. Member for Bury St Edmunds (Jo Churchill) to her place. As I said to her colleague the other day, the shadow Department for Environment, Food and Rural Affairs team is flattered that the Government have felt the need to bring in reinforcements. I wish her well in her role, which is a fantastic job to be doing. I believe her reassurance, which is why we will not be opposing the Bill. I know how Fridays work. It has happened to me before. We know how to do it, but we are not going to.
To be fair, this is not just about the hon. Member’s reassurances or the Minister’s reassurances. In their briefings, both the RSPCA and Battersea Dogs and Cats Home expressed support for the use of fixed-penalty notices to tackle low-level breaches of animal welfare law. That is the crunch of the question that I asked myself about the Bill: how we are sure that it is about low-level breaches.
I am not sure the Government entirely helped themselves in the way the explanatory notes set out the context for the Bill. Anyone coming to them afresh would read through them and not be entirely sure, without the benefit of the hon. Member for Romford’s speech, that they had understood it. I would have thought the starting point would have been the action plan for animal welfare, which sets out the context. In fact, the explanatory notes immediately attack CAP cross-compliance. I just say to Conservative Members: get over it. Labour Members have gotten over it. We are looking ahead. We do not have to keep looking back and replaying the arguments of the past.
If Conservative Members are congratulating themselves on how animal friendly they are, I suggest they visit their local pig farms, if they have them in their part of the country. I went a few weeks ago, and what I saw was very sad. They are overstocked, and the tail biting and aggressive behaviour, and so on, is awful for the animals—it is also pretty awful for the people working with them. I ask hon. Members to reflect, as that is perhaps one of the unforeseen consequences of recent changes. We have to find a solution, because there is nothing animal friendly about 6,000 pigs being culled on farms, with possibly more to come.
There is an attempt to link the Bill with CAP cross-compliance, which we all know has had problems—no one is saying it was a particularly successful system, although these things are not as easy as they might look. We might reflect on that. The way the Bill is framed, those cross-compliance issues have to be related to animals. Having read the explanatory notes, that is not entirely clear.
These are the kinds of things we will be exploring in Committee, because there is a concern about the lack of clarity. The positive spin is that this Bill is an extra tool in the toolbox to aid compliance, which is absolutely fine. If the Bill were to replace the penalties for quite serious offences with the equivalent of a parking ticket, that is not fine. Leaving the choice on where that line is drawn to officials and Ministers through obscure secondary legislation is also not fine.
Although animal welfare organisations support the Bill, their concerns can be discerned in some of the briefings. Battersea says the “beyond all reasonable doubt” criterion that an enforcement authority has to satisfy before issuing a fixed penalty notice could have unforeseen consequences for offences that currently require lower levels of proof. It rightly says that the guidance will be critical to ensuring that there is some uniformity of practice. I welcome the reporting proposals, but the reporting needs to be uniform so it is clear to enforcers when fixed penalty notices are the appropriate tool to use.
Similarly, the RSPCA says
“more discussion will be needed when secondary legislation is laid on which areas will be prioritised and what offences will be covered.”
In my view that is too late. There needs to be more clarity in the Bill, and the Minister has indicated that she appreciates that and that it will be considered in Committee. Indeed, she might wish to consider whether the entire system needs some oversight and whether there is a role for an animal welfare commissioner, as Labour has suggested.
It is perhaps worth asking some basic questions about why the current system does not work, or about the extent to which it does or does not work. Where is the empirical evidence? Has the research been done? If so, can we see it? How many prosecutions have been brought under the various legislation? How many were successful, and what was the effect? How much recidivism has there been?
A cynic might wonder whether this Bill should actually be called the “complete failure of the Tory criminal justice system, (attempt to clear the backlog)” Bill. Although some might see that as unfair, it is the Opposition’s job to ask questions, and we will. If we do not get the answers, we will draw our own conclusions.
We all want the legislation we pass in this place to work, and Sir David and I had exactly this discussion in the Chamber some months ago on his attempt to address the long-standing, vexed issue of tethered horses. He made the good point that if Acts of Parliament are not properly enforced, we find ourselves having the same debate 17 or 20 years later. It is crucial that we get it right.
I am happy to give the Minister the benefit of the doubt. I am not entirely convinced but, provided proper safeguards are introduced in Committee—I am sure I have her word on that—we can go forward together.

Duncan Baker: I am proud to support this Bill, as everybody has said today. I pay tribute to every comment about who is not here but should be.
To lighten the mood somewhat, I congratulate my hon. Friend the Member for Romford (Andrew Rosindell). He is a champion for all animal rights issues. I have not been home for two weeks, because last weekend my family came to London and I was checking out his wonderful work as chair of the all-party parliamentary group on zoos and aquariums with a visit to London zoo. He is right about the magnificent work and conservation that our zoos do in this country. I commend my hon. Friend on his handling of Vivienne, but he also had quite a job handling my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois). [Laughter.] He took his time.
It is fitting that we are talking about this Bill in the same week as the Second Reading of the Animal Welfare (Kept Animals) Bill. As we have been mentioning people’s pets, I cannot fail to highlight my pets briefly. There are my two children’s rescue guinea pigs. If Members are given the option of rescuing guinea pigs, do take it. The only use they serve is keeping the grass very short. The other pet is a rescue cat clearly named after the greatest guitarist of all time, Clapton. His rescue name was Eric.
I am delighted to reinforce our position that we are a global champion for animal rights. As my hon. Friend the Member for Milton Keynes North (Ben Everitt) said, it is worrying that so many complaints are made about cruelty to animals. In particular, there is the  statistic that every 30 seconds, someone raises a call to the RSPCA in England and Wales. I hope the Bill of my hon. Friend the Member for Romford will start to address that. It is a bridging Bill, so it will do that. It is between where custodial sentences are not sufficient and crimes at the other end of the scale where the Bill will begin to take effect.
I have been asked to keep my speech short, but I mention that in North Norfolk, we are clearly an area of enormous animal lovers. You are somewhat in the minority if you are not found on the beach on a Sunday morning with a lead in hand walking the dog. For that reason, I welcome the pet theft taskforce launched in the summer. Many of us in rural constituencies have had huge numbers of animal thefts reported over the pandemic. The Home Office, the Ministry of Justice and the Department for Environment, Food and Rural Affairs all coming together to try to tackle this issue is very welcome. Having constituents too scared to go out and walk their dog for fear of having it stolen is a sad reflection on society. I am very proud and thank my hon. Friend the Member for Romford enormously for the work he is doing to bridge the gap and penalise those who do such a dreadful thing in society as harming animals.

Peter Gibson: I commend my hon. Friend the Member for Romford (Andrew Rosindell) on bringing forward this vital private Member’s Bill today. He has been a long-time campaigner for animal welfare and rights throughout his two decades in this place, and I am proud to support him today.
We must be clear that there is no place in our society for those who abuse and mistreat animals. I know that view is shared by many of my constituents in Darlington. Now that we are free of EU regulations, we are making the most of our ability to strengthen animal welfare laws, increase penalties and stop this heinous crime. I know that is a desire of my hon. Friend, and I know it was a cause close to the heart of our colleague Sir David Amess. I place on record my sadness at the loss of our dear friend. As has already been said, Sir David would have been here today, ecstatic at Vivienne’s victory.
My household is made complete by my three girls: Clemmie, my nine-year-old Jack Russell; Peppy, my seven-year-old Labrador; and Ebony, my four-year-old Labrador—each unique and all providing incomparable special companionship to me and members of my family, particularly my partner’s late grandmother and now my mother-in-law, who lives with us.
I am particularly glad to learn that my hon. Friend’s Bill has the endorsement and whole-hearted support of the RSPCA. It is welcome that the chief executive, Chris Sherwood, has highlighted the impact and effectiveness it would have to quickly combat the suffering of farmed animals, horses and animals kept in zoos. This Bill is another step on the journey to becoming one of the best countries in the world for animals, and I am delighted to support it.

Dehenna Davison: I rise to give my wholehearted support to my hon. Friend the Member for Romford (Andrew Rosindell) for this timely and important Bill, which will close a really important gap.  It is not right that, in effect, the two options available for those committing animal cruelty are a slap on the wrist and a bit of guidance or a prison sentence. To introduce fines that vary depending on the criminality involved would be a fundamentally good thing, and I am pleased to hear a lot of support for the Bill from across the House.
I pay tribute to my hon. Friend the Member for Rushcliffe (Ruth Edwards) for her entertaining tales about her own menagerie. One thing that she said really struck me: pets are people in her household. It is exactly the same for me. I live alone, but I do not because I have my rescue puppy, Carter. I got him from the Dogs Trust in Sadberge, which was fantastic in how it handled the entire adoption process. I adopted him as a puppy, but adopting a terrier puppy is always difficult and came with some challenges.
I will share an anecdote about my little dog being a little bit naughty. Polling day is supposed to be as stress-free as it possibly can be. We all know that that is never going to happen, but my stress levels were massively heightened at one in the afternoon when someone came to the door of one of the houses we were using as a committee room. The door opened, and my puppy Carter was straight out, like a shot, through the gate and on to a main road—an A road. However, I must commend him for playing his part in tackling obesity by making me run a mile and a half down the road to retrieve him before he got hit by traffic. Thankfully, it was not a sad tale on polling day; it turned out fine. I absolutely told him off, burst into tears and gave him a big cuddle because, as my hon. Friend said, pets are people, and my little boy is definitely a valued member of my household. Once again, I pay tribute to my hon. Friend the Member for Romford and give his Bill my wholehearted support.

Richard Holden: I associate myself with the comments made by many hon. Members across the House about Sir David Amess. I know from speaking to him when he was in the Chamber that he was generous to Back Benchers such as me. He will be sadly missed. I am so glad that my hon. Friend the Member for Romford (Andrew Rosindell) and my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) were able to pay extra tribute to him yesterday with Vivienne’s victory.
I have met and remember Carter, the small and very active puppy who belongs to my hon. Friend the Member for Bishop Auckland (Dehenna Davison). However, today I am thinking in particular of Cookie, my family dog, who was on my election campaign in 2019 but sadly died last year. The Government have done a huge amount on animal welfare and this Bill would go another step in that direction. In the Animal Welfare (Kept Animals) Bill that is passing through the House, we are looking to tackle puppy smuggling and attacks on livestock, ban live animals for export and clamp down on issues around primates. One of the most excellent things about this Bill is that it treads the same middle ground on fine levels as other legislation that is going through the House.
I also associate myself with the comments made by my hon. Friends the Members for North Norfolk (Duncan Baker) and for Milton Keynes North (Ben Everitt)  about pet theft, which has been a massive issue in my constituency. It is great to see the Government doing something about that.
Finally, I pay tribute to the great work of Farplace Animal Rescue in Weardale, which has centres across the country, and Westway Vets, which has done a huge amount to push me to support measures in this area. I hope that my hon. Friend the Member for Romford continues his great work. Perhaps microchipping could be the next animal welfare campaign that he could really push on.

Tom Randall: I congratulate my hon. Friend the Member for Romford (Andrew Rosindell) on introducing the Bill. He rightly praised the late Sir David Amess for his passion on animal rights issues, but we should also recognise his commitment. He speaks with passion on a number of subjects, but it is on animal rights and animal welfare that he speaks with the most passion of all. I am sure that he is proud to introduce the Bill, which follows in a long line of measures introduced by the Government.
The Government have a good recent record on animal welfare issues, from banning wild animals on travelling circuses to cracking down on live animal exports, passing the Animal Welfare (Sentencing) Act 2021—that Act is popular with my constituents—and introducing the pet theft taskforce and the pet abduction offence that has arisen from that. Pet abduction is of great concern among many constituents who have written to me. This Bill should be seen as following in that tradition. As others have explained, with the cross-compliance system under the common agricultural policy being wound down as CAP payments are being wound down, there is an enforcement gap between issuing the advice and pursuing a criminal prosecution, which can allow offences to slip through the net. This Bill will fill that gap. It is great to see that in this House we are able to realise some of the benefits of Brexit by introducing a simpler and more efficient system, and I look forward to this Bill coming on to the statute book very shortly.

Jo Churchill: As was the case for everybody, my first and pleasurable task is to thank my hon. Friend the Member for Romford (Andrew Rosindell) for introducing this important Bill and for the passion and commitment he has shown on this issue, not only today, but for decades—many Members have referred to that. He has been concerned with caring for and looking after, and I, too, think that there is no more fitting tribute than that picture we saw this morning of him with Vivienne in his arms, which was just beautiful. I hope that our friend Sir David Amess is looking down and smiling on two individuals of whom he could not have been fonder.
Penalty notices will be an important tool in encouraging animal keepers to follow the rules and discourage them from committing more serious offences. The Bill is meant to be there in the middle for the redirection of behaviour, as has been so ably explained. It has the Government’s full support and we will do all we can to  make sure that its passage through the Commons and Lords is as collaborative as possible, because I agree with my hon. Friend that getting legislation right is what we are all here to do.
I pay tribute to all those who contributed today: my hon. Friends the Members for Broxtowe (Darren Henry), for Rushcliffe (Ruth Edwards), for Hyndburn (Sara Britcliffe), for Newcastle-under-Lyme (Aaron Bell), for Milton Keynes North (Ben Everitt), for Runnymede and Weybridge (Dr Spencer), for North Norfolk (Duncan Baker), for Darlington (Peter Gibson), for Bishop Auckland (Dehenna Davison), for North West Durham (Mr Holden) and for Gedling (Tom Randall). I think that in only two contributions were we not shown that we are a complete nation of pet lovers, in not only the way we articulate it, but in the fact that we spend our lives rescuing and loving those four-legged friends, who, in the main, behave, Andrew notwithstanding. I have thoroughly enjoyed hearing about Poppy, Godfrey, Andrew, Geoffrey, Magic, Ninja, Frazzle, Clapton, Clemmie, Peppy, Ebony, Carter, Cookie and any I may have missed. I think the guinea pig has a hard time and it did not actually get named. I would love to add to that list my special Wellington, who is at home with a bit of a lampshade on at the moment.
Some 44% of us in this country keep a pet, and in the Department for Environment, Food and Rural Affairs we understand the importance of that. We also understand that farming is more than just a job, as my hon. Friend the Member for Milton Keynes North pointed out, and the majority of our farmers could be no better examples of people who love our animals. I am proud that this Government will continue to elevate our reputation for animal health and welfare in this country. We have a long tradition of protecting animals, as has been said. The UK was the first country in the world to pass legislation on this, with the Cruel Treatment of Cattle Act 1822. Recently, this House paid tribute to Sir David, but I just wish to reference the fact that he campaigned so diligently for animal welfare, as it was so important to him. He was responsible for introducing the Protection against Cruel Tethering Act 1988 and if this Bill goes forward to Committee, we could discuss how it might help take things forward in that area—my right hon. Friend the Member for Harlow (Robert Halfon) mentioned the issue only yesterday. It is precisely the sort of area we may wish to introduce this penalty notice in.
Sir David also campaigned to stop the testing of domestic products on animals, tackled the illegal wildlife trade and fought to end puppy farming. If he were here today, he would be joining this debate, with his humour. It is such a sad loss that we do not have him here.
We are continuing in the vein of innovating with legislation on this matter. Earlier this year, we published the action plan for animal welfare, setting out our aims and ambitions across the piece. In spring 2022, we will launch the animal health and welfare pathway, starting with a fully funded vet visit eligible to all farmers. The Animal Welfare (Sentencing) Act 2021 gained Royal Assent this year, as has been mentioned during the debate. We are planning further improvements to the lives of animals in a number of other areas, including setting up a pet theft taskforce. However, it strikes me that many areas are beating us to it. Through the Animal Welfare (Kept Animals) Bill that was debated in this place on Monday, we have begun steps to ban primates as pets.  My hon. Friend the Member for Romford also spoke on that Bill. We will certainly also make good on the manifesto commitments to introduce compulsory microchipping for cats, and to address the issue of excessively long journeys for slaughter and fattening.
Robust enforcement for animal health and welfare touches the hearts and minds not only of individuals in this place, but of each and every constituent we have, no matter where we sit in this House. The Bill will fundamentally reform the way in which we enforce animal health and welfare across all farmed animals and kept animals in England. It will strengthen and safeguard animal health and welfare, building on the skeleton of the existing domestic enforcement framework. As my hon. Friend the Member for Romford said, there are currently few options beyond prosecution or that guidance, so we are widening the suite of available enforcement tools.
This will be one of the first opportunities to reform how we enforce our high animal health and welfare standards for farm animals now that we are outside the EU and as we move away from cross compliance, hopefully supporting our continued position as a world leader in animal health and welfare. The new system will use a mix of sanctions, advice and guidance to deliver high domestic animal health and welfare standards, thereby enhancing productivity, stopping the spread of disease and so on, and giving confidence to consumers and international trading partners.
Let me turn to a couple of comments made by the hon. Member for Cambridge (Daniel Zeichner). He asked whether there will be proper safeguards. We can look at the numbers through the reporting mechanism. I agree with him that more discussion needs to take place, and it will. We are committed to working with non-governmental organisations, relevant industries and enforcers pre-consultation to identify appropriate priority offences.

Ben Everitt: Does the Minister have any views on to what extent this is an issue on which we can lead the world? We are proud of our high animal welfare standards in the UK and we have a new global outlook. Are there opportunities to influence the rest of the world for the better on this issue?

Jo Churchill: It is always better to lead in areas of good behaviour than to follow. Perhaps if we work together, we can find ourselves in that sweet spot where we have the right suite of tools to ensure that where there is inappropriate behaviour, we are firm; where there is inappropriate behaviour at a low level because of a lack of knowledge, we can guide; and where there is something in between, we can use my hon. Friend the Member for Romford’s penalty notice to ensure that we can redirect that behaviour. We will be identifying priority offences to establish clear and effective guidance, and to ensure that serious offences continue to go through the court,  which I think was the point that my hon. Friend the Member for Romford made to me yesterday and on the Floor of the House today.
Let me reiterate the Government’s unwavering support for this legislation. I give my commitment that I will do all that I can as the Bill proceeds through the House.

Nigel Evans: Before handing over to the Member in charge, may I say that the spirit of Sir David Amess has filled the Chamber today throughout this debate? I have no doubt whatsoever that had the tragedy not befallen Sir David, he would have been here today: he would have spoken and it would have been both caring and comical in equal measure. We miss him.

Andrew Rosindell: This is a great day because we have new legislation that will enhance animal welfare in our country, but it is sad because, as so many Members have mentioned, we are missing the greatest champion of animal welfare, Sir David Amess. We do miss him, but he will be looking down, giving us his support today, and Vivienne’s victory yesterday is an enormous tribute to him and everything he stood for in championing animal welfare in his entire time in Parliament.
I thank all hon. Members for their incredible support and very kind remarks today. I will not mention everybody, but it is lovely to know that the work of not only myself but all Members over the years to get to where we are today in being such a world leader in animal welfare has been acknowledged. There was a time when animal welfare was not on anyone’s agenda very much, but today it is a cross-party thing: all of us in this Chamber are absolutely committed to the highest standards of animal welfare we can possibly attain.
My Bill is going to bridge the gap in respect of those who do not care for animals in the way they should. It is not just about cruelty, but about mismanagement, things that are missed, and dealing with things in a proportionate way. I am very pleased that the shadow Minister, the hon. Member for Cambridge (Daniel Zeichner) has been reassured and has acknowledged that this is a good piece of legislation; we can amend it in Committee and look at ways to improve it, and I know the Minister is committed to doing that as well, but I hope it will unite all of us. I say that because almost all our constituents are animal lovers; we are a nation of animal lovers. So let us be true to them and true to the animals in our care, and pass this legislation and work together cross-party to ensure that we continue in the United Kingdom to be the world leader in animal welfare.
Question put and agreed to.
Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).

Approved Premises (Substance Testing) Bill

Second Reading

Rob Butler: I beg to move, That the Bill be now read a Second time.
First, I declare my interest as a former non-executive director of Her Majesty’s Prison and Probation Service and a magistrate member of the Sentencing Council. I also want to thank all those, including Clerks, Whips, officials and the Minister, who helped me to get the Bill to this stage.
I have risen in this House on several occasions to speak about our prison and probation services, and I have paid tribute to the staff working in them, whom I genuinely consider to be the hidden heroes of our public services, but there is an important aspect of our justice system that I have not thus far highlighted: approved premises. Indeed, while many people are familiar with prisons and probation, there is much less awareness of approved premises, yet they provide a critical step in the rehabilitation of offenders. Let us never forget that rehabilitation means there will be less reoffending, and that in turn means fewer victims of crime—something each and every one of us in this House must surely welcome.
Approved premises are essentially hostels which provide temporary accommodation for people who have been released from prison but are considered to present the highest risk to the community. They also house a small number of people on bail as well as high-risk offenders serving community sentences. There are just over 100 APs in England and Wales, with about 2,300 bed spaces between them, and the average stay in them is 12 weeks. The role of approved premises is to ensure that those with the highest risk and most complex needs receive additional, targeted residential supervision and rehabilitative support.
Unfortunately, the number of deaths among approved premises residents has increased over recent years, and many of those deaths are believed to be related to taking drugs. As a result, the independent prisons and probation ombudsman has rightly made repeated recommendations about the urgent need for a comprehensive drugs strategy for the approved premises estate. I am sure that I surprise no one when I say that the use of drugs in approved premises can have a significant impact on the physical and mental wellbeing of residents in both the short and the long term. Of course, drug use also undermines a person’s ability to engage in work or other activities that would help their rehabilitation.
My Bill today is a response to this problem. It would enable approved premises to create a comprehensive framework for drug testing, and it would also bring them in line with the substance testing regime in prisons. This was established by the Prisons (Substance Testing) Act 2021, which was the private Member’s Bill promoted by our greatly missed colleague and my constituency neighbour Dame Cheryl Gillan. I was proud to serve on the Bill Committee for that legislation, and I am delighted to say that it received Royal Assent earlier this year, having been supported by all parties in this House, as I hope my Bill will be.
Currently, residents in approved premises can be tested for drugs only at the request of staff, in accordance with the house rules that are a condition of their residence. Although that provides a basis for drug testing, it does not set out a comprehensive statutory framework for the testing of illicit substances, the scope of substances for which testing can be conducted or the types of sample that may be taken. I submit that that needs to change.
One reason for the need for more formalised and widespread testing is that patterns of drug misuse in both custody and the community are changing. In particular, psychoactive substances have become much more prevalent within the illicit economy in approved premises. These are particularly unpleasant, and one of the most worrying aspects of them is their unpredictable impact on different individuals. Some people become catatonic after taking them. Others suffer convulsions, vomiting or temporary loss of vision. Still others become anxious, aggressive or even engage in extreme behaviours that almost defy the imagination. They can easily pose a serious danger to others and indeed to themselves.

Richard Holden: I am grateful to my hon. Friend for speaking on this. I well remember the debate we had in Committee, when I picked up that Bill from Dame Cheryl, on prisons testing and substance misuse. I also remember speaking to those from the Prison Officers Association during the passage of that Bill, and they said to me that some of the interactions they were having with prisoners were off the scale, even compared with the issues they had with controlled substances, with prisoners attempting to commit suicide, in absolute rages and totally uncontrollable. Are those the sort of examples he is trying to pin down with this Bill so that things like that in treatment centres in the community can be addressed?

Rob Butler: My hon. Friend is absolutely right. Those are exactly the types of behaviour that cause real concern. I would like to take the opportunity to thank him for picking up the mantle on that prisons Bill from Dame Cheryl Gillan. He talked about the Prison Officers Association, and it is worth mentioning that, according to a recent staff survey in approved premises, the main substance of choice in those premises is now psychoactive substances, so anything we can do to stamp out their use is bound to be of benefit.
A further challenge comes from prescription and pharmacy medicines, which can also be abused by some residents when medication is brought into the premises from outside. That may have been legally obtained by somebody else or it may have been imported, but it is then taken by residents in an illicit way to get high, and that can at times even prove lethal. Yet the current drugs testing regime in approved premises can test only for four groups of drugs—opioids, cannabis, cocaine and amphetamines. Therefore, first, my Bill will extend the range of substances that can be tested to cover all forms of psychoactive substance as well as prescription and pharmacy medicines, in addition of course to the existing drugs. Alongside that, the Bill also introduces urine testing rather than the currently used oral fluid testing. There are relatively few drugs that can in fact be detected reliably in oral fluid. That means that the current testing regime is unable to identify much of the potential drug use among residents. As a result, it is not possible to tackle the problem.

Ben Everitt: I am interested in exploring my hon. Friend’s point about the scope of the testing. As Members across the House will know, legislating to proscribe drugs is something of a retrospective game because almost every week more drugs appear on the market and in head shops. We seem to be chasing our tail when it comes to these things, and they can be harmful or they can be innocent. Where would he place the limit on the scope of testing?

Rob Butler: That has been addressed recently through legislation to ensure that the appropriate Department can incorporate different types of psychoactive substances so that there does not need to be primary legislation on each and every occasion a new substance is named. It is very easy to tinker with one or two of the chemical elements, thereby taking them out of the scope of what is illegal and what is legal. Thankfully, that has been addressed, so it would apply to this proposed legislation as well, making sure that we were not always chasing our tails. I thank my hon. Friend for making that very important point.

Aaron Bell: I am grateful to my hon. Friend for promoting this Bill. It is clear that he speaks with great authority on the matter. From reading the notes and listening to him speak, it seems to me that the danger is not just to the people taking the drug. In the case of prescription medicine, residents who are trying to go straight are being bullied by residents who are trying to get the drugs off them. Could he set out how the testing regime he envisages would protect people who are desperately trying to be rehabilitated, go straight and become productive members of society again?

Rob Butler: My hon. Friend makes an interesting point. That can indeed be a risk, although having had conversations this week with the staff and management of approved premises, I have been reassured to learn that, for the most part, the staff look after any prescription medicines and issue them to residents at the appropriate time. Therefore, there is a little less concern than one might have thought about residents obtaining those drugs from others through distinctly unhelpful ways such as bullying. In fact, the current concerns seem to be rather more as I have described them—namely, people from outside obtaining substances legally and then sharing them illicitly, or, indeed, substances being obtained from overseas via the internet. My hon. Friend raises an important point and I know that the management of approved premises in Her Majesty’s Prison and Probation Service are keen to tackle it. They believe that they have already taken serious steps through their regime of handing out medication.
Let me turn to the reasons why it is preferable to test via urine. It is very clear that this will enable a wider range of substances to come under a testing regime. It will also, importantly, extend the time period in which testing can identify drug use. That is because some drugs are detectable for only 12 to 24 hours when using oral fluid, whereas when using urine, drugs such as heroin are detectable for up to five days.
The second aspect of my Bill aims to ensure that the Government understand the prevalence and nature of substance abuse in approved premises. It would allow HMPPS to use resident samples to test for the prevalence of various substances on an anonymised basis.

Sara Britcliffe: I thank my hon. Friend for bringing this important topic to the Chamber. Why does not the Bill suggest follicle samples as another means to test for substances?

Rob Butler: I thank my hon. Friend for raising that point, although I only half-thank her because I have to say that it is not a measure that I have thus far considered. I will take her up on it and find out more. If the Bill passes its Second Reading, I hope that she will serve on the Committee, so perhaps we could explore her suggestion at that stage. In the meantime I will endeavour to find out more, but I regret that that will probably not happen before I finish speaking today.
Prevalence testing on an anonymised basis would be key to helping HMPPS understand the ever changing drug landscape, and it would allow staff to take appropriate action to tackle the threat of drugs in those premises.

Ben Spencer: What is your feeling about what the current prevalence is? You mentioned four different drug groups and the extent of the testing required. When the testing happens, what do you expect the most prevalent drugs will be?

Nigel Evans: Just a reminder not to use the word “you”, please.

Rob Butler: I thank my hon. Friend for that intervention. The problem is that we do not know, and that is the reason to introduce prevalence testing. We know about individual cases where people have died, unfortunately, but we do not know the number of people who have taken drugs but it has not been detected. That is the whole purpose of introducing the Bill. If it passes and the measures are implemented, we will, in 12, 24 or 36 months, have a much clearer idea of the prevalence, but I would not want to hazard a guess on something that we do not yet know. My hon. Friend almost underlines the rationale for my Bill.

Tom Randall: This is an interesting debate on a subject in which I was not particularly well versed. These premises are in a community. If drugs are being taken, is there a knock-on effect on antisocial behaviour in the community, such as robbery or theft to fund drug taking? If so, would increased testing help to improve the standing and status of approved premises and make them more acceptable?

Rob Butler: My hon. Friend raises a very plausible scenario, but I am not aware of any specific evidence to suggest that. There is quite a strict regime in approved premises around the behaviour of residents. For example, they are required to abide by a curfew and their behaviour is very carefully scrutinised. If their behaviour is in breach of the rules, there are possible sanctions that could ultimately lead to a recall to prison. However, he highlighted a danger area. At present, most of the concern is about the wellbeing of individuals in the premises and, once they leave the premises and move into the community more widely, the danger of their continuing a drug habit that would likely lead them to engage in illegal behaviour. But ideally, the further testing that the Bill would introduce would reduce the chance of people succumbing to that temptation.

Angela Richardson: It is clear that the Bill aims to reduce the number of drug-related deaths on approved premises and help with the rehabilitation  of offenders, but in widening the scope of what my hon. Friend wants to test for, what sanctions would be in place for those who possess, supply and use the increased range of substances?

Rob Butler: I will say a bit more about sanctions later, but first, and most importantly, the aim in approved premises is to help people on their journey to rehabilitation. If somebody fails a drugs test, the first step will be for the staff to engage in conversation with them, try to work out what the causes are and direct them towards the appropriate substance misuse organisation. Every single approved premises in the country—there are approximately 100—has a link with a substance misuse premises that can do that. However, if that behaviour were to continue, as I mentioned, more punitive sanctions are possible and could be implemented. If people were caught in possession of drugs of whatever type—let alone if there was a fear of supply—they would, of course, be subject to normal police intervention. If necessary, that would lead to a prosecution, but that would be beyond the scope of my Bill and in the normal course of the law, as it stands.

Dehenna Davison: I pay tribute to my hon. Friend’s fantastic campaigning on all matters of criminal justice since he got into the House. He is a true champion of this cause and I am grateful to him for bringing in the Bill. I am reassured to hear that early intervention is in place for those who fail drugs tests, but does he agree that we are sometimes too quick to recriminalise people who are really trying to rebuild their lives and that a more restorative approach is the right way forward?

Rob Butler: My hon. Friend’s point is absolutely spot on. That is why the first step will be to try to encourage people to help themselves. The answer to stopping people reoffending is not always to come down incredibly harshly the first time that people make a mistake. I remember that when I was involved with the Youth Justice Board I asked some young people, “What would you really like me to take away from my conversation with you, given that you have committed an offence?” They said, “That one mistake does not define your entire life.”
It is important to get the balance right: not letting people off if they commit offences time after time, but adopting a progressive approach. That is what the Bill seeks to do, and it is, I think, what the Government’s approach to criminal justice is all about. We need to be very tough at the hard end, but we also need to give people the opportunity to live a crime-free life if they can be helped to do that through positive interventions, rather than criminalising them.

Jane Hunt: I entirely agree with my hon. Friend. People must serve their sentences, but then be given the opportunity to change, because that is how we really reduce reoffending,

Rob Butler: Absolutely
Let me now say a little more about the consequences if someone tests positive, to make sure that I have it on the record. The first step is a discussion with the resident, which should lead to a plan to help them tackle the  problem and stop using drugs with the support of the substance misuse services to which I referred earlier. The aim, as I have said repeatedly, is rehabilitation. Of course, if the drug use continued or resulted in wider problems—as mentioned by my hon. Friend the Member for Gedling (Tom Randall)—that could lead to breach proceedings or, in extremis, a recall to prison.

Natalie Elphicke: I know that my hon. Friend shares my concern that, during the pandemic, prisons were largely shut down, with training, education and skills, as well as drug support and other medical interventions, no longer available to prisoners. Is it not vital for the Government to take urgent steps to support prisoners in the way that my hon. Friend has described, so that when they come out, they can move forward in their lives?

Rob Butler: I agree with my hon. Friend. Throughout the pandemic, Ministers have frequently come to the Justice Committee to talk to us and account for what is going on in prisons.
At the beginning of the pandemic, given the presence of so many people in such close and confined circumstances, it was feared that prisons could easily become super-spreader locations, and it is a huge tribute to the staff in our prisons, at all levels, that that did not happen. In fact, the number of people who succumbed to covid-19 on the custodial estate was very small indeed. Achieving that required restrictions of their normal activities, on the rehabilitation programmes and so on, and of course we want to overcome that as quickly as possible, but I think that the key aim has been to save lives, and I pay tribute to HMPPS for achieving that.
I have had the opportunity to talk to staff involved in running approved premises, and they believe that their colleagues—and, importantly, residents—would welcome these proposals. My final word—

Richard Holden: Will my hon. Friend give way?

Rob Butler: It will not be my final word, because I am taking another intervention!

Richard Holden: I was a special adviser in the House of Lords during the passage of the Psychoactive Substances Act 2016. That Act specifically excluded caffeine, which is by far the most broadly used psychoactive substance available. I note that the Bill does not currently refer to the exclusions in the Act, but merely mentions psychoactive substances. Will my hon. Friend assure me that at a later stage—perhaps in Committee, if his Bill makes it that far—caffeine will be excluded, so that I shall be able to support the Bill’s Second Reading?

Rob Butler: I hope that my hon. Friend will support the Bill today, and that sounded like a very good effort at volunteering to be a member of the Bill Committee. I am now drawing to a conclusion, and I beg the indulgence of my hon. Friends in not making further interventions for the moment.
The Bill may seem fairly insignificant or even trivial to some, but drug use is pervasive. It is so often the major driver in the commission of crimes. In the 12 years that I spent as a magistrate, I lost count of the number of defendants who appeared in front of me either because  they were stealing to feed their habit, or because they had committed the offence when they were high. Anything we can do to help people steer clear of drugs, including psychoactive substances and illicit medication, has the potential to cut crime.
The House has the opportunity today to support provisions that would enable us to better identify and respond to new and emerging patterns of drug use in approved premises, which would help to reduce the number of drug-related deaths and, ultimately, support reductions in reoffending. I hope that the benefits I have laid out in some detail are clear and that the Bill will gain support from Members on both sides.

Alex Cunningham: I congratulate the hon. Member for Aylesbury (Rob Butler) on bringing the Bill forward. I know that he has tremendous experience in the area, and he is a great asset to this place in that respect, but I was a bit concerned that he would talk out his own Bill.
The hon. Gentleman outlined clearly the context for the Bill. As we are content to support Second Reading, I will be brief. As we have heard, residents who are supervised in approved premises are not typical offenders. Often, they are high-risk individuals with previous additional problems and troubled pasts. For that reason, it is crucial that those who are housed in that type of premises can access a safe and secure environment that will support their rehabilitation and promote their wellbeing. Critical to that is ensuring that residents are protected from the supply of illicit drugs, which may have led many of them to offend in the first place.
Substance abuse ruins the lives not only of the people who become dependent on drugs, but of their friends, families and loved ones, as is very clearly the case when I talk to affected families in my constituency. Moreover, it plays a huge factor in offending and reoffending. Labour supports the principle of the Bill, which would give offender managers the powers they need to clamp down on illicit drugs in approved premises and, by doing so, to protect those in their care and prevent their reoffending.
Under the Offender Management Act 2007, residents of approved premises are required to submit to drugs tests if requested by members of staff, but we accept that the current testing framework is far from perfect. In particular, we share the concerns that, in the 14 years since the Act was enacted, patterns of drug misuse in custody, and in the community for that matter, have changed considerably. That is particularly evident in the huge number of new psychoactive substances available that are constantly evolving and becoming harder to detect and combat.
As the hon. Gentleman said, the Bill would allow offender managers to use urine testing rather than oral fluid testing to allow them to detect a far wider range of drugs over a longer period than currently, and then tackle their misuse. As Members will be aware, in recent years, psychoactive substances have become far more prevalent across approved premises and prisons. Similarly, there has been an alarming rise in the number of offenders abusing prescription drugs that have been prescribed for genuine medical purposes.
This is not just about further criminalising offenders. Giving offender managers the tools to better understand the types of drugs that are being abused in approved premises will allow them to better support those in their care. Not only will that improve the rehabilitation of individual residents, but it will decrease the risk to members of the wider public.
The misuse of drugs, prescription drugs and psychoactive substances is a growing problem within our prisons and youth offending institutions. It is also a problem in our approved premises, as we have heard. If we are to have any hope of breaking the cycle between offending and reoffending, we need to take action. We look forward to discussing the Bill in Committee.

Peter Gibson: It is a privilege to speak in support of this important Bill. I thank my hon. Friend the Member for Aylesbury (Rob Butler) for bringing forward this legislation, which fundamentally supports rehabilitation services across the country. I am proud to support the Bill to update ageing legislation that has left assisted premises staff without the appropriate and necessary legislative support that they need to do their jobs.
Fundamentally, our prison system must focus on the rehabilitation of offenders, as we prepare them for life after they are released. We know, however, that following their release, a minority of individuals deemed to be at high risk of harm or reoffending need the supervision and support that only specialised centres can provide. Each and every assisted premises across the UK is there to protect and support bailees as they transition from their custodial release back into society. Approved premises are rightly in place to ensure that these offenders with the highest risk and most complex needs receive the additional residential supervision and rehabilitative support that they often need following release from custody.
While there are no assisted premises within the boundaries of my constituency, the Tees Valley is served by two premises in Middlesbrough. Nelson House and The Crescent provide the specialised support that a number of individuals locally need to prevent further harm from being caused. They also provide a safe, suitable temporary home, ensuring that these vulnerable offenders do not end up on the street.
These centres provide a range of engaging activities, events and skills classes for their residents to participate in. Over the past year, this has included marking and celebrating awareness days, such as LGBT awareness, mental health awareness and Macmillan coffee mornings, as well as important cultural and religious days of significance. It has also included the provision of skills sessions chiefly focused on supporting residents once they move on from those premises. I read with interest that one such course was Skills 2: Employment Day, where residents were taught real world practical skills to make them more employable and how to make the most of opportunities presented to them.
While staff at the centres across the country continue to support their residents and prepare them for reintegration, we know that the ageing Offender Management Act 2007 is failing to keep pace with changes in the drugs problem and improving drug testing technology. Sadly, that has led to concerns being raised regarding the fact  that the number of deaths among approved premises residents has increased in recent years. I understand that many of these deaths are believed to be drug related.
Indeed, we know that psychoactive drugs have become more prevalent in approved premises, hampering the efforts of staff to protect and rehabilitate individuals, while bullying sees the hoarding and abuse of prescription medication. I am glad that this short, yet impactful Bill grants staff the legislative powers that they need to prevent the wider prevalence of drug misuse within their premises and to tackle ever-changing and evolving drug patterns.
At the heart of the Bill, staff at Her Majesty’s Prison and Probation Service are empowered with the power they need to monitor and control the misuse of controlled psychoactive and prescriptive drugs. Under clause 1, approved premises managers can authorise assisted premises staff to ask for and require a urine sample from any resident rather than an oral fluid test. It was interesting to hear the intervention from my hon. Friend the Member for Hyndburn (Sara Britcliffe) with regard to the challenge on hair follicle testing. It is, however, important to highlight that the Bill rightly imposes restrictions on how this sample may be acquired and places a duty on the Secretary of State to publish guidance on the exercise of drug testing in these sites. The sample can then be used to identify a controlled drug, a prescription-only medicine or a psychoactive substance within the resident’s body.
I am glad that the Bill builds on the recommendation of the prisons and probation ombudsman, who, in 2017, called for more effective drug testing practices and better staff guidance to identify and address the risks associated with substance misuse. The Bill places approved premises on a much firmer legislative footing and I am pleased to support it today.

Ben Spencer: It is great to rise to speak on this very important Bill, which has been introduced by my hon. Friend the Member for Aylesbury (Rob Butler).
I just want to make a few brief points in the limited time that I have. I appreciate that my hon. Friend cannot answer the question on the prevalence of different types of drugs, but, clearly, drug use in prisons and approved premises is rife. It is responsible for a lot of misery, delaying people and causing them problems in their rehabilitation process. The more that we can do on drug testing and offering drug testing, the better, particularly in terms of being able to offer proper treatment, packages and pathways for people going through the criminal justice system.
It is worth reflecting on the harms that drug use causes to people. We talk a lot about the harms to society, but there are also harms to people themselves. The most dangerous time to be a heroin user when a person is going through the judicial system is when they leave prison. When they leave prison, they get access to heroin again, take far more than they are used to and have heroin overdoses. It is important we make sure that people are detected and we get them on proper treatment plans so they can be rehabilitated back into society.
I thank my hon. Friend the Member for Aylesbury again for tabling the Bill, which will hopefully make a huge difference in protecting our society and, importantly, helping people on the path to rehabilitation.

Kit Malthouse: I am extremely grateful to my hon. Friend the Member for Aylesbury (Rob Butler), who gave a comprehensive speech that is difficult to top. He was obviously rehearsing for being a Minister, given the number of interventions he took. I hope he will excuse me if I do not take any.
This Bill is very important, and we look forward to it completing its passage. As my hon. Friend said, it continues from the Prisons (Substance Testing) Act 2021, which was another private Member’s Bill that received Royal Assent with support from both sides of the House. I am grateful for the support of the hon. Member for Stockton North (Alex Cunningham), too.
As a number of Members have said, this Bill makes sure we can understand and react quickly to the changing patterns of drug misuse in approved premises, as drug misuse often hampers individuals’ chances of rehabilitation. As Members may be aware, around 80% of crime that receives a caution or conviction is committed by a repeat offender, and around 62% of prisoners have either an alcohol or drugs need, or both.
Combating drug misuse is a priority for the Government. In January this year we announced £148 million to institute a system-wide approach to the problem of illegal drugs, with £80 million of new money being invested in treatment and recovery services beyond the prison gate.
One of the projects I am proud to have founded is Project ADDER, a joint Home Office, Department of Health and Social Care and Public Health England initiative that combines targeted and tougher policing with enhanced treatment and recovery services. Through Project ADDER, work is under way to improve outcomes for offenders with substance misuse needs in prison and within the ADDER geographies.
It is also important that work to tackle substance misuse continues outside prison. We know the detrimental impact that drugs can have on an individual, both physically and mentally. Having a comprehensive framework of substance testing in place will be vital in ensuring that approved premises are safe and drug free, and that the risk of serious harm is reduced for the individual, other residents and, most importantly, the wider public. This Bill does two things. It enables us to implement a rigorous drug-testing framework, enabling mandatory drug testing for psychoactive substances and prescription and pharmacy medicines. Supported by the change to urine testing, we can reliably test for a wider number of substances for longer. Urine testing gives us a date when drugs were taken, whereas I am afraid that follicle testing does not. A positive follicle test could mean that drugs were taken months before. The Bill will also put prevalence testing on a firmer statutory footing that allows us to better identify emerging trends and ensure we are able to react quickly.
The combined measures set out in the Bill are intended to help us to tackle the use of drugs in approved premises and ensure that staff can respond effectively and put the necessary care planning in place. This will in turn  support our commitment to rehabilitate offenders and, as a number of Members said, get them on to the straight and narrow and give them a second chance, not least because that is one of the key planks of reducing crime overall.
Everyone who has taken part in this debate has my gratitude, not least for their brevity and their commitment to this issue.

Rob Butler: With the leave of the House, I thank Members on both sides of the House for their support for my Bill. I particularly pay tribute to my hon. Friends the Members for Darlington (Peter Gibson) and for Runnymede and Weybridge (Dr Spencer) for their speeches, and to many other colleagues for their thoughtful interventions.
I am particularly grateful to the hon. Member for Stockton North (Alex Cunningham) for his words of support, and I take all his comments on board. I look forward to working together if this Bill progresses.
I also repeat my appreciation to those who have assisted me on the Bill’s progress so far. I feel sure that if the Bill eventually reaches the statute book, it will bring real benefits to society. Everybody present here today will have contributed to that. All our communities are touched by crime, and we all know that drugs play a major part. We will all have shared in clamping down on that crime and reducing the number of victims.
I am very grateful to the Minister for his expert knowledge of follicle testing, which I hope answered the question of my hon. Friend the Member for Hyndburn (Sara Britcliffe).
I have no more to say other than, “Thank you very much indeed.” I look forward to continuing to work with all my colleagues to get this Bill on to the statute book.
Question put and agreed to.
Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).

Business without Debate

Crown Estate (Devolution to Wales) Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 18 March.

BBC Licence Fee Non-Payment (Decriminalisation for Over-75s) Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

Caravan Sites Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

Green Belt (Protection) Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

Climate and Ecology Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 10 December.

Public Sector Exit Payments (Limitation) Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

General Election (Leaders’ Debates) Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

Motor Vehicles (Compulsory Insurance) Bill

Bill read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).

Covid-19 Vaccine Damage Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

Hospitals (Parking Charges and Business Rates) Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

Voter Registration Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

Asylum Seekers (Return to Safe Countries) Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 19 November.

Planning (Street Plans) Bill

Motion made, That the Bill be now read a Second time.

Hon. Members:: Object.
Bill to be read a Second time on Friday 3 December.

NHS Allergy Services

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

Jon Cruddas: I rise to make a series of points about improving allergy services in the UK and to speak in support of numerous recommendations made this week by the all-party parliamentary group on allergy and the National Allergy Strategy Group in their report, “Meeting the challenges of the National Allergy Crisis”. I will begin on a positive note and say how much the allergy community appreciated the fact that the Minister made time in her busy diary to receive the document at her Department on Wednesday morning. She spent time talking to children living with multiple allergies, as well as health professionals and charities. We hope that that will be the beginning of an ongoing dialogue.
Allergy is a hypersensitivity reaction or an exaggerated sensitivity to substances—allergens—that are normally tolerated. Examples include peanuts, milk, shellfish, cats, medicines and grass pollens. They can trigger harmful antibodies and the release of inflammatory chemicals, causing symptoms such as sneezing, itches, rashes and falls in blood pressure, yet they may also cause airway narrowing, shortness of breath and wheezing, and swelling which, if in the mouth, throat or airway, causes severe difficulty in breathing and can be life-threatening.
The simple truth is that there is a modern-day epidemic in allergy—one neglected by the NHS. Recent high-profile tragic cases of fatal anaphylaxis have brought shortcomings in NHS service provision, and a lack of wider public understanding of allergy, into sharp focus. This week’s report therefore calls for a new national strategy to help the millions of people across the UK affected by allergic disease. It also calls for an influential lead for allergy—some have labelled it an allergy tsar—to be appointed who can implement such a strategy.
By way of background, we have been here before, and quite regularly. Over the past two decades, a series of reports have reviewed the prevalence of allergic diseases, consequent patient need and UK service provision. The list includes earlier reports from the all-party parliamentary group that I am fortunate to chair, plus two Royal College of Physicians reports in 2003 and 2010, the first titled, “Allergy: the unmet need”. The 2003 report was so scathing that in 2006, the Department of Health conducted “A review of services for allergy”. We have also had a 2004 Commons Health Committee report on “The Provision of Allergy Services”, as well as the 2007 House of Lords Science and Technology Committee report, “Allergy”. All have consistently highlighted how allergy remains poorly managed across the NHS due to a lack of training and expertise. All recommended significant improvements in specialist services, as well as improved knowledge and awareness in primary care.
That is not to say nothing has changed. We have seen National Institute for Health and Care Excellence guidelines on allergy and care pathways for children with allergic disease, but very little has changed. Allergy remains under-resourced across the national health service, so once again this week’s document makes similar arguments and recommendations to earlier reports. We do not  apologise for that, because so little has changed over the past 20 years. Actually that is not entirely the case. Something significant has changed over the past two decades: there has been a dramatic upsurge in the numbers of those affected by various allergic conditions across the country.
The figures speak for themselves. Around one in three people, which is 20 million of our fellow citizens in the UK, have an allergy-related disorder. A significant amount of that is severe or complex, whereby one patient can suffer several disorders, each triggered by different allergens. Five million have conditions severe enough to require specialist care. Fatal and near-fatal reactions occur regularly due to foods, drugs and insect stings and have been increasing over recent years. Hospital admissions due to allergy rose by 52.5% in the six years to 2017-18. Admissions with anaphylaxis—rapid onset and often life-threatening reactions—rose by 29%. It is estimated that one in 1,333 of the population in England has experienced anaphylaxis at some point in their lives.
Prevalence rates for allergy in the UK are among the highest in the world, especially among the young. Some 40% of children in the UK have been diagnosed with some form of allergy. Each year, new births add 43,000 cases of child allergy to the population in need, yet specialist services delivered by trained paediatric allergists are available to only a minority of those with serious disease. One in four adults and about one in eight children in the UK has allergic rhinitis, which includes hay fever and animal and house dust mite allergy. That is roughly 16 million people. They are four times more likely to suffer from asthma, eczema and food allergy. The percentage of people diagnosed with allergic rhinitis, asthma and eczema has trebled over the past four decades.
The overall economic case for prevention-oriented allergy services is very strong. The estimated cost of allergy-related illness in 2004 was £1 billion. Since then, there has been a 200% to 300% increase in anaphylaxis-related admissions. The starkest figure is that primary care visits for allergy have increased to account for 8% of total GP consultations. Put simply, the complexity and severity of allergies have increased, as well as the number of patients affected, placing huge strains on the system. Those are the basic facts. Change is long overdue.
Beyond the statistics, for the growing number of people in the UK living with allergic disease, their condition can have a significant negative impact on their lives and their families’ lives. It is frightening and restrictive to live with a condition that could cause a severe or life-threatening reaction at any time. Despite the shocking statistics, each of the reports that I have mentioned concludes that allergy has largely been ignored and is poorly managed across the NHS owing to a lack of training and a lack of expertise.
The core problem is that there are a very small number of consultants in adult and paediatric allergy, while most GPs receive no training in allergy at all. The basic mismatch between rising demand and poor service supply needs correction. There are only 11 specialist allergy trainee posts for doctors in England, despite the 2004 report’s recommendation of a minimum of 40. Only two qualify each year—fewer than in Lithuania, which has a population of 3 million.
The tiny number of allergy trainees is a bottleneck, stifling growth of the specialty. Shockingly, despite repeat submissions over 20 years to the workforce bodies  responsible for trainee numbers, there has been very little increase. There are also too few consultants, only 40 adult allergists and a similar number of paediatric allergists working in a small number of allergy centres across the country.
Most general practitioners receive no training in clinical allergy, either as medical students or in their specialist GP training. The consequences for NHS patients are that they face an extraordinary postcode lottery across the country; that they are hampered by wrong referrals and re-referrals, or get no referral; that they are denied choice and the benefits of improvements in allergy care; and that there is significant and enduring unmet need.
The new training programme in allergy from August 2021 combines allergy with a different specialism in clinical immunology, but the danger is that that will further dilute and downgrade the quality of allergy specialist training. Meanwhile, on the ground, there is growing evidence of a reduction in some allergy services, with closures or restrictions, mainly among secondary care providers, because they are so overburdened.
Paradoxically, the UK is world-leading in allergy research and UK allergy guidelines are highly regarded internationally, yet failure to invest in clinical services nationally means that NHS provision is inconsistent, is often poor and in many areas falls far below that in other developed countries. More generally, the covid-19 pandemic has highlighted a new need for allergists to support the vaccine roll-out. The major new workload that arose—investigating anaphylaxis and suspected allergic reactions to the covid-19 vaccines and providing advice on safe vaccinations—has been delivered by a small cadre of allergists, building on their drug allergy expertise.
All these issues, and the resulting lack of effective allergy care, need to be recognised and corrected by NHS England and Health Education England. Basically, the report makes four recommendations for action. The first is a national plan for allergy, making allergy a priority, investing in a national plan led by a designated Department of Health and Social Care civil servant or NHS lead with sufficient authority to implement change—a national clinical director of allergy—and bringing together medical professionals and patient support organisations to develop the strategy and improve allergy services. The report details a list of organisations that might be involved in the delivery of training programmes to meet allergy need and provide the education across primary care that is needed for health visitors, dieticians and other healthcare professionals.
The second recommendation is on specialist care: to expand the specialist workforce as a priority, and to ensure that training programmes prioritise allergy, so that specialists of the future are appropriately trained and can safely deliver care. It proposes a minimum of 40 additional training posts for allergy, and a minimum of four consultant allergists for adults and two paediatric allergists in every major teaching hospital and large conurbation.
The third recommendation is on primary care: to ensure that all GPs and healthcare professionals in primary care have knowledge of allergic disease; to ensure allergy is included in the GP curriculum and exit examination; to improve allergy education for already qualified GPs in ongoing professional appraisal; and to appoint a health visitor and/or a practice nurse in each practice  with sufficient training to be responsible for allergy. Again on a positive note, some of this is beginning to happen. The Royal College of General Practitioners has recently added allergy to new GP exams.
The fourth recommendation is on commissioning: to ensure that local commissioners understand the allergy needs of their population. It says that it is not adequate to assume that other specialties can deliver specialist allergy care; that commissioners should ensure access to adult and paediatric allergy consultants, and allergy pathways; and that national commissioners should ensure national agreements on commissioning, including for immunotherapy, drug allergy investigation and so on.
In conclusion, I hope that the Department will seriously consider the report and its recommendations. Supporting the growth of the allergy speciality would give more patients access to accurate diagnosis, which should surely be expected in a modern national health service. We can all agree that patient safety, the prevention of severe life-threatening reactions and the control of chronic disease are paramount. More specialist allergists are essential to support primary and secondary care, and to improve integrated care, keeping more patients out of hospitals. This would in turn tackle the geographical inequalities and lack of access to specialist allergy services. A relatively small investment would be an effective multiplier and deliver wider dividends.
Such a model would result in better care for patients in line with the NHS long-term plan. The Government and the NHS should give allergy the priority it deserves and recognise the true burden that it can place on those affected, their families and wider communities. They should not have to wait any longer. This report offers the solutions to the problems and makes sensible, achievable recommendations for change. We look forward to them being implemented.

Gillian Keegan: I thank the hon. Member for Dagenham and Rainham (Jon Cruddas) not only for securing this debate on this important issue but for arranging for me to meet, on Wednesday, the wonderful APPG to receive a copy of its report in person.
The Government recognise the challenges faced by people with allergies and are taking a number of actions to further support them. Allergies affect around 20 million people in the UK. For most, they are mild, but for some they are severe and can be fatal. That was the case for 15-year-old Natasha Ednan-Laperouse, who sadly passed away in 2016. Thanks to the tireless work by Natasha’s parents, Tanya and Nadim, and their charity, the Natasha Allergy Research Foundation, Natasha’s law came into force in October this year. That milestone legislation sets out the legal requirement for all food retailers and operators to display full ingredient and allergen labelling information on every food item they sell pre-packed for direct sale. This will give the millions throughout the UK who are living with food allergies and intolerances better protection and more confidence in the food they buy.
We know how important it is that healthcare professionals, people with allergies and those close to them have the information that they need about the safe  and effective use of adrenaline auto-injectors—AAIs—when they are administered in an emergency situation. That is why the Medicines and Healthcare Products Regulatory Agency is developing a communications campaign to convey key messages to improve the safe and effective use of AAIs, including the need to carry two AAIs at all times.
People with allergies continue to be supported through locally commissioned services but, to support patients with more complex conditions, NHS England and NHS Improvement also directly commission some specialised services such as specialist allergy clinics.
As with all conditions, we acknowledge that we need to have the right professional support in place for people living with allergies, including national clinical leadership. We have already established a clinical reference group for specialised allergy and immunology services, chaired by Dr Tomaz Garcez, a consultant immunologist. Membership includes clinicians, commissioners, public health experts, patients and carers. They use their combined knowledge and expertise to advise NHS England on the best ways to provide those specialist services. To support clinicians in the implementation of clear care pathways, the NICE website has guidance to support diagnosis and treatment of a range of allergy conditions, including how to identify allergies, when to refer to specialist care, and how to ensure allergies are recorded in people’s medical records.
The importance of getting that right was emphasised to me when I had the privilege of meeting people on Wednesday, when the all-party group shared its report. In particular, I was personally touched by the story of the two young boys I met, Arlo and Monty, who suffer from serious allergies. The report rightly emphasises the need and the importance of having a highly skilled workforce educated in allergy diagnosis and treatment to ensure that they can appropriately support people in managing their conditions. I have agreed to meet the hon. Gentleman and other representatives from the group to discuss that important issue further. I also plan to arrange a roundtable meeting in due course, so we can understand what additional help is required.
On ensuring we have the right workforce in place, there has been some encouraging progress. However, we know that more can be done. We are working with HEE to increase the uptake in available training places. The latest figures to June 2021 show that the number of doctors, and doctors in training, in specialist allergy and immunology has increased. I know there are already many dedicated medical professionals working in allergy and immunology specialisms.
Relevant training is the responsibility of the Royal College of Physicians, with a certificate of completion of training in allergy and immunology available to support specialist allergy care. The RCP also runs an accreditation scheme, improving quality in allergy services. Currently, there are seven accredited NHS trusts in England: North Bristol NHS Trust; Nottingham University Hospitals NHS Trust; Royal Brompton and Harefield Hospital NHS Foundation Trust; University Hospitals of North Midlands NHS Trust; University Hospitals Birmingham NHS Foundation Trust; University Hospitals of Leicester NHS Trust; and University Hospitals Plymouth NHS Trust. A further 22 trusts across the UK are working towards accreditation. In addition, the British Society for Allergy and Clinical Immunology provides training  for primary care staff across the country through workshops and education. The Royal College of General Practitioners has developed an allergy e-learning online resource to support CPD and revalidation, which aims to educate GPs about the various presentations of allergic disease, how to access an atopic patient, and when to investigate in primary care or refer to secondary care.
Looking to the future, we continue to invest in research to improve the health outcomes of those living with allergies. Over the past five years, the Department of Health and Social Care has awarded the National Institute for Health Research over £2 million for research into food allergies. It is currently funding two trials investigating food allergy using oral immunotherapy, including one that compares two treatments for an allergy to cows’ milk in babies and another which seeks to overcome severe allergic reactions to peanuts in adults.
This is a very important debate, and I genuinely thank the hon. Gentleman for bringing it forward. I look forward to working with him to improve services. The NHS works really hard to care for all its patients, including those suffering from allergies, mild or severe. I  want to ensure that all adults and children, like Monty and Arlo, living with allergies continue to receive the best care possible and feel safe and confident in the care that they receive. We will continue to work with our delivery partners and stakeholders to ensure that we have the workforce, clinical leadership and expert guidance in place to best support those living with allergies.
Finally, I want to say a special thank you to Arlo and Monty. On Wednesday, during half-term, they gave up their time and, when most other children were out and about enjoying activities, they got here early with their parents to present the report to me. They looked fantastic and spoke very wisely. That really brought home to me the maturity of young children who have to live with allergies, with all the things they need to know and all the personal responsibility they need to take. I will do all that I can to make life better for them and others like them.
Question put and agreed to.
House adjourned.